1952468274 NPI number — DELFRED LAURIE CHRIS DIEHL M.D., FRCSC

Table of content: DELFRED LAURIE CHRIS DIEHL M.D., FRCSC (NPI 1952468274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952468274 NPI number — DELFRED LAURIE CHRIS DIEHL M.D., FRCSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIEHL
Provider First Name:
DELFRED
Provider Middle Name:
LAURIE CHRIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., FRCSC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952468274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34581
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-1581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-326-3131
Provider Business Mailing Address Fax Number:
206-326-2094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 15TH AVE E
Provider Second Line Business Practice Location Address:
GROUP HEALTH COOPERATIVE: OPHTHALMOLOGY CNB-5
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98112-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-326-3131
Provider Business Practice Location Address Fax Number:
206-326-2094
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD00026231 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8116014 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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