Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | S1799 | TX |
NPI | 1013361195 |
---|---|
Provider Name | Scott Dieste |
First Address | Houston, TX 77059-6523 |
Second Address | El Paso, TX 79905-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 02/03/2020 |