| Brian D Dieterle Md Pc | |
|
670 Branson Landing Blvd Ste 2 Branson MO 65616-2063 | |
| (417) 334-0810 | |
| (417) 334-6685 |
| Full Name | Brian D Dieterle Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 670 Branson Landing Blvd Ste 2, Branson, Missouri |
| Authorized Official Name and Position | Brian D Dieterle (PRESIDENT) |
| Authorized Official Contact | 4173340810 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian D Dieterle Md Pc 670 Branson Landing Blvd Ste 2 Branson MO 65616-2063 Ph: (417) 334-0810 | Brian D Dieterle Md Pc 670 Branson Landing Blvd Ste 2 Branson MO 65616-2063 Ph: (417) 334-0810 |
| NPI Number | 1942487137 |
|---|---|
| Provider Enumeration Date | 01/30/2008 |
| Last Update Date | 10/25/2023 |
| Medicare PECOS PAC ID | 1658456355 |
|---|---|
| Medicare Enrollment ID | O20080305000322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942487137 | NPI | - | NPPES |
| 203602404 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 102259 (Missouri) | Primary |
| Provider Name | Brian D Dieterle |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518920412 PECOS PAC ID: 7416039474 Enrollment ID: I20080129000733 |
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