DR. MARVIN LEROY DIETRICH (NPI# 1619925401) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619925401 |
| Entity Type | Individual |
| Full Name | DR. MARVIN LEROY DIETRICH |
| Credential | M.D. |
| Practice Address |
10503 W Thunderbird Blvd #301 Sun City AZ 85351-3022 |
| Mailing Address |
18922 E Tonto Verde Dr Rio Verde AZ 85263-5200 |
| Practice Telephone | 6239743647 |
| Practice Fax Number | 6239770310 |
| Mailing Telephone | 4804713426 |
| Mailing Fax Number | 4804713428 |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VG0400X |
Obstetrics & Gynecology Specialization: Gynecology |
27044 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | CIGNA | 6248578-004 | 01 |
| NE | STATE LICENSE | 11541 | 01 |
| AZ | CAQH UNIVERSAL PROVIDER # | 11172652 | 01 |
| AZ | STATE LICENSE | 27044 | 01 |
| AZ | AZ BC/BS | AZ0885510 | 01 |
| AZ | DEA | AD5983728 | 01 |
| Street Address |
10503 W THUNDERBIRD BLVD #301 |
| City | SUN CITY |
| State | AZ |
| Zip Code | 85351-3022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487643920 | Kumar L Ravi | Internal Medicine | 10503 W Thunderbird Blvd, Ste 103, Sun City, AZ 85351-3022 | 2005-10-18 |
| 1821596875 | Sarah Elizabeth Bade | Physical Therapist | 10503 W Thunderbird Blvd, Sun City, AZ 85351-3022 | 2018-01-24 |
| 1578070066 | Bhsm Rehabilitation, LLC | Durable Medical Equipment & Medical Supplies | 10503 W Thunderbird Blvd, Sun City, AZ 85351-3022 | 2018-01-05 |
| 1689126591 | Julia D'angelo | Physician Assistant | 10503 W Thunderbird Blvd, 366, Sun City, AZ 85351-3022 | 2016-10-26 |
| 1720482912 | Philip Jordan Ristvedt | Physician Assistant | 10503 W Thunderbird Blvd, Ste 262, Sun City, AZ 85351-3048 | 2014-10-16 |
| 1447502968 | Advanced Audiological Associates, LLC | Audiologist-Hearing Aid Fitter | 10503 W Thunderbird Blvd, Suite 114, Sun City, AZ 85351-3022 | 2012-10-08 |
| 1104176627 | Morris Bruce Hamburg | Nurse Practitioner | 10503 W Thunderbird Blvd, Suite 262, Sun City, AZ 85351-3022 | 2012-09-12 |
| 1063788875 | Todd Christopher Herman | Specialist | 10503 W Thunderbird Blvd, Suite 262, Sun City, AZ 85351-3022 | 2012-03-26 |
| 1427368885 | Ahmad Nizam | Specialist | 10503 W Thunderbird Blvd, Ste 262, Sun City, AZ 85351-3022 | 2010-10-19 |
| 1902116965 | Mara Lee Hall | Physician Assistant | 10503 W Thunderbird Blvd, Ste 262, Sun City, AZ 85351-3048 | 2010-10-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467003566 | T&h Hearing LLC | Hearing Aid Equipment | 13616 N. 99th Ave., Sun City, AZ 85351 | 2019-09-20 |
| 1881247682 | Amanda M Neri | Physician Assistant | 10401 W. Thunderbird Blvd Md Anderson - Banner Boswell, Sun City, AZ 85351 | 2019-07-20 |
| 1649822313 | Azmed Rehab LLC | Family Medicine | 14281 North Del Webb Blvd, Sun City, AZ 85351 | 2019-07-12 |
| 1982182267 | Akdhc, LLC | Internal Medicine | 10249 W Thunderbird Blvd Ste 100, Sun City, AZ 85351 | 2018-07-30 |
| 1871084814 | Amy Mikulec | Physical Therapist | Banner Physical Therapy and Rehab Boswell, 10503 W Thunderbird Blvd Suite 263a, Sun City, AZ 85351 | 2018-05-25 |
| 1194238345 | Lorie Jo Matthews | Nurse Practitioner | 10494 W Thunderbird Blvd Ste 102, Sun City, AZ 85351 | 2017-11-09 |
| 1184153363 | Susan Jane Hockman | Registered Nurse | 14601 N Delwebb Blvd, Sun City, AZ 85351 | 2017-06-09 |
| 1043769169 | Medsource Orthotics & Prosthetics, Inc | Prosthetic/Orthotic Supplier | 13203 N 103rd Ave Ste J1&j2, Sun City, AZ 85351 | 2016-09-30 |
| 1033563002 | Vittoria Giovannucci | Technician/Technologist | 10503 W Thunderbird Blvd Ste 101a, Sun City, AZ 85351 | 2016-04-15 |
| 1669858379 | Qui Nguyen | Pharmacist | 10660 Nw Grand Ave, Sun City, AZ 85351 | 2015-08-04 |
| Find all providers in zip 85351 | ||||
| Taxonomy Code | 207VG0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720618374 | Denise Lynn Gallus | Obstetrics & Gynecology | 1000 Willow Creek Rd Ste E, Prescott, AZ 86301-1645 | 2020-01-23 |
| 1417471954 | Samuel R Blakesley | Obstetrics & Gynecology | 6522 E Carondelet Dr Ste A, Tucson, AZ 85710-2197 | 2017-07-26 |
| 1326493768 | Desert Princess Medical Grp | Obstetrics & Gynecology | 9377 E Bell Rd Ste 131, Scottsdale, AZ 85260-1503 | 2016-05-03 |
| 1124414834 | Rachel Eliason | Obstetrics & Gynecology | 500 W Thomas Rd Ste 660, Phoenix, AZ 85013-4247 | 2015-04-09 |
| 1568889939 | Anthea Dixon Md Ltd | Obstetrics & Gynecology | 5190 E Farness Dr Ste 106, Tucson, AZ 85712-2142 | 2014-03-24 |
| 1205174729 | Scott Alan Rovner | Obstetrics & Gynecology | 7619 E Medlock Dr, Scottsdale, AZ 85250-7720 | 2013-01-17 |
| 1336486679 | Raul A Osorio Md PC | Obstetrics & Gynecology | 6242 E Arbor Ave Ste 118, Mesa, AZ 85206-1309 | 2013-01-07 |
| 1255632295 | John Leroy Kallmeyer, M.d. | Obstetrics & Gynecology | 11122 E. Rusty Spur Pl., Tucson, AZ 85749 | 2010-11-08 |
| 1750556338 | Judith C Scott | Obstetrics & Gynecology | 215 S Power Rd Ste 218, Mesa, AZ 85206-5238 | 2008-04-24 |
| 1033389911 | Gynecolgy Center of Phoenix | Obstetrics & Gynecology | 2222 E Highland Ave Ste 225a, Phoenix, AZ 85016-4885 | 2008-03-06 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.