Provider Demographics
NPI:1386901072
Name:DIEBOLT, ERIK STUART (DO)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:STUART
Last Name:DIEBOLT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4011
Mailing Address - Fax:512-901-3950
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4011
Practice Address - Fax:512-901-3950
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17618208100000X
TXR7708208100000X
NC2015-00461208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3105502Medicaid
NC0397730004Medicare NSC
NCNCN464AMedicare PIN
NCNCN464AMedicare PIN