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1083626386
WAYNE DIEDRICK
HOLLYWOOD, FL
NPI
1083626386
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363AS0400X Physician Assistant Surgical
(Licence: FL PA3021)
Enumeration Date
2006-08-13
Last Update Date
2007-07-08
Business Address
WAYNE DIEDRICK PA
3501 JOHNSON ST
HOLLYWOOD, FL 33021-5421
Phone number: 954-987-2020
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Mailing Address
WAYNE DIEDRICK PA
PO BOX 862233
ORLANDO, FL 32886-2233
Phone number: 954-276-5575
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