Doctor Name: | DR. DESIREE DEE DIEBOLD |
NPI Number: | 1013254135 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DPM |
License Number: | TR-128 |
Business Practice Address: | 2817 Reilly St Fort Bragg, NC - 283107324 |
Business Phone Number: | 9109078658 |
Business Fax Number: | |
Mailing Address: | 2817 Reilly St, FORT BRAGG |
State: | NC |
Postal Code: | 283107324 |
Phone Number: | 9109078658 |
Fax Number: | |
NPI Enumeration Date: | 01/09/2013 |
NPI Last Update Date: | 07/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | TR-128 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |