Martin Lee Dierks JR., IDC

NPI #1902132434 in De Soto, Missouri

Provider Information

NPI Number: 1902132434
Entity Type: Individual
Name: Martin Lee Dierks JR., IDC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Military Health Care Provider - Independent Duty Corpsman
Credential: IDC
Enumeration Date: Oct 17, 2009
Last Updated: Oct 17, 2009

Practice Location

Address: 2915 PARTHENON DR
City: De Soto
State: Missouri
ZIP Code: 63020-4645
Phone: (757) 650-8436

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Military Health Care Provider - Independent Duty Corpsman — Independent Duty Corpsman	1710I1002X	Primary

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