Dieter, Jonathan L

Dieter, Jonathan L is an sole proprietor health care provider with primary practice located at 8014 Myrtle Trace Dr , Conway SC 29526-8945. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Dieter, Jonathan L can be contacted via phone (843) 347-7224.

Contact Information

Primary practice address
8014 Myrtle Trace Dr Conway SC 29526-8945
Phone: (843) 347-7224
Fax: (843) 347-7335
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 7055 South Carolina

Profile Details

NPI number 1205987419
LBN Legal business name Dieter, Jonathan L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 15th, 2007
Last updated Oct 10th, 2007 - about 17 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 1205987419 NPPES
South Carolina MEDICAID PC4269

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