Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A124317 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | A124317 | CA |
NPI | 1366731960 |
---|---|
Provider Name | Dr. Joseph W Diehl III |
First Address | Sn Luis Obisp, CA 93405-1811 |
Second Address | Sn Luis Obisp, CA 93405-1811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 12/12/2018 |