Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0800X | Chiropractor Orthopedic Specialist | 11230 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 776968 | TX |
NPI | 1114159142 |
---|---|
Provider Name | Dr. James Monroe Dieter III |
First Address | Pasadena, TX 77505-3097 |
Second Address | Pasadena, TX 77505-3097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2009 |
Last Update Date | 01/08/2013 |