Provider Demographics
NPI:1902872294
Name:DIETZ, DUANE ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:ALLAN
Last Name:DIETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:248 PLEASANT ST STE G100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2588
Mailing Address - Country:US
Mailing Address - Phone:603-230-1970
Mailing Address - Fax:603-230-1971
Practice Address - Street 1:248 PLEASANT ST STE G100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-230-1970
Practice Address - Fax:603-227-7573
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH98852083P0011X, 207Q00000X
NH167512083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130560907Medicaid
TX130560907Medicaid
TXF34679Medicare UPIN