MR. JOHN BRETT DIETZE (NPI# 1588665319) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588665319 |
| Entity Type | Individual |
| Full Name | MR. JOHN BRETT DIETZE |
| Credential | MD |
| Practice Address |
2602 Saint Michael Dr Ste 302b Texarkana TX 75503-5228 |
| Mailing Address |
P O Box 9600 Dept 09-019 Texarkana TX 75505-9600 |
| Practice Telephone | 9037944196 |
| Practice Fax Number | 9036145169 |
| Mailing Telephone | 9037944196 |
| Mailing Fax Number | 9037927408 |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2019-11-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | K2152 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| INDIGENT HEALTH CARE | 141100101 | 01 | |
| TX | CIGNA DME | 1871793307 | 01 |
| US DEPT OF LABOR | 179117500 | 01 | |
| FIRST PYRAMID LIFE | 98601 | 01 | |
| TX | COLLUM & CARNEY CLINIC | 98601 | 01 |
| AR | QUALCHOICE OF ARKANSAS | 18796000000 | 01 |
| TX | CIGNA GOVERNMENT SERVICES | 5575000001 | 01 |
| TX | WORKERS' COMPENSATION | MDK2152 | 01 |
| OK | 200023040A | 05 | |
| AR | BLUE CROSS | 98601 | 01 |
| TX | 141100101 | 05 | |
| TX | RAILROAD MEDICARE | 140006859 | 01 |
| AR | 142238001 | 05 | |
| TX | BLUE CROSS | 8A0896 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1002 Texas Blvd, Suite 406, Texarkana, TX 755015113 | 9037944196 | 9037927408 |
| Street Address |
2602 SAINT MICHAEL DR STE 302B |
| City | TEXARKANA |
| State | TX |
| Zip Code | 75503-5228 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306312822 | Michael Chad Elliott | Physician Assistant | 2602 Saint Michael Dr Ste 302b, Texarkana, TX 75503 | 2018-10-23 |
| 1093929150 | Marcus Andrew Smith | Specialist | 2602 Saint Michael Dr Ste 302b, Texarkana, TX 75503-5228 | 2007-05-09 |
| 1215952965 | Sherry Lynn Missildine | Nurse Practitioner | 2602 Saint Michael Dr Ste 302b, Texarkana, TX 75503-5228 | 2006-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770049397 | Jeffery Nash | Nurse Practitioner | #4 Valley View Circle, Texarkana, TX 75503 | 2019-02-19 |
| 1821583501 | Brandy D Acker | Psychologist | 3615 Richmond Rd, Texarkana, TX 75503 | 2018-06-26 |
| 1366935066 | Samantha Lee Harris | Nurse Practitioner | 4116 Mcknight Rd, Texarkana, TX 75503 | 2018-06-07 |
| 1811416910 | Heather Alison Gerber | Nurse Practitioner | 5903 Brenda Street, Texarkana, TX 75503 | 2017-09-11 |
| 1952838682 | John Kyle Abney | Counselor | 4134 Mcknight Rd, Texarkana, TX 75503 | 2017-05-12 |
| 1699151514 | Piney Woods Er IIi LLC | Clinic/Center | 4102 Gibson Lane, Texarkana, TX 75503 | 2015-08-03 |
| 1609282433 | Colby Rebecca Pair | Physician Assistant | 2604 St. Michael Dr., Suite 310, Texarkana, TX 75503 | 2014-07-01 |
| 1265842496 | Healthcare Express, LLP | Clinic/Center | 3513 Richmond Rd, Texarkana, TX 75503 | 2014-04-28 |
| 1134540628 | Eagle Dental Center of Texarkana Pllc | Dentist | 4009 Moores Ln, Texarkana, TX 75503 | 2013-12-30 |
| 1326481664 | Juancarlo S. Pascual | Family Medicine | 604 St. Michael Dr, Suite 340, Texarkana, TX 75503 | 2013-04-16 |
| Find all providers in zip 75503 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821014648 | Brian Keith Willis | Neurological Surgery | 1002 Texas Blvd Ste 406, Texarkana, TX 75501-5113 | 2006-07-14 |
| 1407273287 | Collom and Carney Clinic Association | Neurological Surgery | 5002 Cowhorn Creek Rd, Texarkana, TX 75503-9766 | 2014-03-18 |
| 1871793307 | Neurosurgical Associates of Texarkana | Neurological Surgery | 1002 Texas Blvd, Suite 406, Texarkana, TX 75501-5113 | 2007-07-23 |
| 1558413427 | Neurosurgical Associates of Texarkana, Inc. | Neurological Surgery | 1002 Texas Blvd Ste 406, Texarkana, TX 75501-5113 | 2007-01-18 |
| 1447250659 | Freddie L Contreras | Neurological Surgery | 1002 Texas Blvd, Ste 406, Texarkana, TX 75501-5113 | 2005-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447869003 | Scott B Phillips Pllc | Neurological Surgery | 1303 Mccullough Ave Ste 166, San Antonio, TX 78212-5603 | 2020-07-29 |
| 1710595996 | Laredo Surgical Center | Neurological Surgery | 10410 Medical Loop Bldg 4a, Laredo, TX 78045-6672 | 2020-07-14 |
| 1710506803 | Houston Texas Neurosurgical Institute. Pllc | Neurological Surgery | 925 Gessner Rd Ste 500, Houston, TX 77024-2644 | 2020-04-09 |
| 1760046080 | Adam Franklin Carlton | Neurological Surgery | 301 University Blvd # Mr 0517, Galveston, TX 77555-0517 | 2019-04-23 |
| 1235698911 | South Texas Neurosurgery Associates | Neurological Surgery | 3475 W Alton Gloor Blvd Ste A, Brownsville, TX 78520 | 2019-03-13 |
| 1376009951 | Dallas Center for Neuro and Spine Excellence LLP | Neurological Surgery | 4013 Centenary Ave, Dallas, TX 75225-5430 | 2019-02-19 |
| 1679040414 | Advances Istitute for Joint and Spine Disorders | Neurological Surgery | 6160 Windhaven Pkwy Ste 200, Plano, TX 75093-2138 | 2018-10-30 |
| 1891270989 | Alma Diana Garza | Neurological Surgery | 1139 E Sonterra Blvd Ste 301, San Antonio, TX 78258-4348 | 2018-09-25 |
| 1861975922 | Neurosurgical Group of Texas, LLP | Neurological Surgery | 8731 Katy Fwy Ste 325, Houston, TX 77024-1703 | 2018-09-13 |
| 1508347998 | William T Mccullough Md Pa | Neurological Surgery | 1101 Raintree Cir Ste 12o, Allen, TX 75013-4922 | 2018-08-24 |
| Find all providers with the same taxonomy | ||||
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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.