Diedrich, Richard Grenville
Diedrich, Richard Grenville is an individual health care provider with primary practice located at 1001 D W. Broadway , Farmington NM 87401. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Diedrich, Richard Grenville can be contacted via phone (505) 327-4796.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | NM 80-29 | New Mexico |
Profile Details
| NPI number | 1255363149 |
|---|---|
| LBN Legal business name | Diedrich, Richard Grenville |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 7th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255363149 | NPPES |
| New Mexico | MEDICAID | 27870 |
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