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 |
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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 |
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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 |
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Provider Enumeration Date | 01/30/2008 |
Last Update Date | 10/25/2023 |
Medicare PECOS PAC ID | 1658456355 |
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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 |
Drs Family Medical Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 118 N 3rd St, Branson, MO 65616 Phone: 417-334-3655 Fax: 417-334-3614 | |