Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G36970 | CA |
N | 207PP0204X | Pediatric Emergency Physician | G36970 | CA |
N | 208000000X | Pediatrician | G36970 | CA |
NPI | 1306973615 |
---|---|
Provider Name | Ron Dieckmann |
First Address | Oakland, CA 94618-2122 |
Second Address | Oakland, CA 94618-2122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 29/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G369700 | (05) | CA |
A46889 | (02) |