Dietrich, William G

Dietrich, William G is an individual health care provider with primary practice located at 1 Shircliff Way , Jacksonville FL 32204-4748. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Dietrich, William G can be contacted via phone (989) 356-7390.

Contact Information

Primary practice address
1 Shircliff Way Jacksonville FL 32204-4748
Phone: (989) 356-7390
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X ME55253 Florida

Profile Details

NPI number 1952397036
LBN Legal business name Dietrich, William G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 23rd, 2005
Last updated Jan 11th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952397036 NPPES
Florida Other 930051064 RRMCR
Florida Other 12806 RRMCR
Florida MEDICAID 055296800 RRMCR

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