Diede, Jackson Ray

Diede, Jackson Ray is an individual health care provider with primary practice located at 810 E 23Rd St , Sioux Falls SD 57105-2135. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sports Medicine, which is considered as his primary health care specialty. Diede, Jackson Ray can be contacted via phone (605) 331-5890.

Contact Information

Primary practice address
810 E 23Rd St Sioux Falls SD 57105-2135
Phone: (605) 331-5890
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 2081S0010X 0714 South Dakota

Profile Details

NPI number 1760054373
LBN Legal business name Diede, Jackson Ray
Credentials MAT, ATC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 13th, 2021
Last updated Jul 13th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760054373 NPPES
South Dakota Other WSLW01080864 BLUECROSS BLUESHIELD

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