MARTIN LEE DIERKS JR. (NPI# 1902132434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902132434 |
| Entity Type | Individual |
| Full Name | MARTIN LEE DIERKS JR. |
| Credential | IDC |
| Practice Address |
2915 Parthenon Dr De Soto MO 63020-4645 |
| Practice Telephone | 7576508436 |
| Mailing Telephone | 7576508436 |
| Enumeration Date | 2009-10-17 |
| Last Update Date | 2009-10-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| Street Address |
2915 PARTHENON DR |
| City | DE SOTO |
| State | MO |
| Zip Code | 63020-4645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700435385 | Patsy Maness | Technician | 5100 Knorpp Road, De Soto, MO 63020 | 2019-09-06 |
| 1013268911 | Jane Susann Brenneke | Counselor | 116 B 2nd Street, Desoto, MO 63020 | 2012-10-02 |
| 1477634277 | Wal-mart Stores East, Lp | Technician/Technologist | 12862 State Road 21, De Soto, MO 63020 | 2006-10-18 |
| 1235109877 | John W Dickinson | Dentist | 704 N Main Street, Desoto, MO 63020 | 2006-01-25 |
| 1700883253 | Valle Ambulance District | Ambulance | 12363 State Route 21, De Soto, MO 63020 | 2005-06-30 |
| 1568893105 | Terence A. Friskel | Dentist | 110 North Main, Desoto, MO 63020 | 2013-12-09 |
| 1457541427 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 12977 State Route 21, De Soto, MO 63020-1000 | 2007-07-26 |
| 1982880084 | Thomas L. Monje, O.d. | Optometrist | 26 Jefferson Sq, De Soto, MO 63020-1031 | 2008-01-18 |
| 1548266737 | Steven Crawford | Family Medicine | 12 Jefferson Sq, De Soto, MO 63020-1031 | 2005-06-22 |
| 1720595200 | Danielle Marie Howerton | Nurse Practitioner | 12 Jefferson Sq, De Soto, MO 63020-1031 | 2018-01-05 |
| Find all providers in zip 63020 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144406265 | Mark A. Strange | Military Health Care Provider | 1222 Spruce St, Room 2-102a, Saint Louis, MO 63103-2818 | 2008-01-18 |
Please comment or provide details below to improve the information on MARTIN LEE DIERKS JR..
| 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.