Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 53879 | AZ |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 53879 | AZ |
NPI | 1437440070 |
---|---|
Provider Name | Christopher Michael Diefenbach |
First Address | Flagstaff, AZ 86001-3118 |
Second Address | Flagstaff, AZ 86001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2011 |
Last Update Date | 18/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13767358 | CAQH (01) |