Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35058401 | OH |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 35.058401 | OH |
NPI | 1013008275 |
---|---|
Provider Name | John W Dietrich |
First Address | Akron, OH 44333-1782 |
Second Address | Akron, OH 44333-1782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0755339 | (05) | OH |
C34760 | (02) | OH |