Provider Demographics
NPI:1316913635
Name:DIETZE, DONALD DAVID JR (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:DAVID
Last Name:DIETZE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:29301 N DIXIE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445
Mailing Address - Country:US
Mailing Address - Phone:985-871-4114
Mailing Address - Fax:985-871-4130
Practice Address - Street 1:29301 N DIXIE RANCH RD
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445
Practice Address - Country:US
Practice Address - Phone:985-871-4114
Practice Address - Fax:985-871-4130
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-10-01
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Provider Licenses
StateLicense IDTaxonomies
LA019033207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5E706OtherMEDICARE PROVIDER NUMBER
LA5E706OtherMEDICARE PROVIDER NUMBER