Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | TR-128 | NC |
NPI | 1013254135 |
---|---|
Provider Name | Dr. Desiree Dee Diebold |
First Address | Fort Bragg, NC 28310-7324 |
Second Address | Fort Bragg, NC 28310-7324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2013 |
Last Update Date | 28/07/2015 |