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1255363149
RICHARD GRENVILLE DIEDRICH
FARMINGTON, NM
NPI
1255363149
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
208000000X Pediatrics
(Licence: NM NM 80-29)
Enumeration Date
2006-07-07
Last Update Date
2007-07-08
Business Address
RICHARD GRENVILLE DIEDRICH MD
1001 D W. BROADWAY
FARMINGTON, NM 87401
Phone number: 505-327-4796
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Mailing Address
RICHARD GRENVILLE DIEDRICH MD
116 PINE RIVER RANCH CIR
BAYFIELD, CO 81122-9325
Phone number: 970-884-4831
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