Dallas Diederich, PA-C

NPI #1982729216 in Flint, Texas

Provider Information

NPI Number: 1982729216
Entity Type: Individual
Name: Dallas Diederich, PA-C
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Mar 19, 2007
Last Updated: Aug 7, 2015

Practice Location

Address: 20208 STATE HIGHWAY 155 S
City: Flint
State: Texas
ZIP Code: 75762-5600
Phone: (903) 825-6222

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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