JACK DIEP

LAKE HAVASU CITY, AZ
NPI1912333014
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy208VP0014X Pain Medicine, Interventional Pain Medicine
(Licence: AZ  55528)
Additional Taxonomies207LP2900X Anesthesiology, Pain Medicine
(Licence: AZ  55528)
208VP0000X Pain Medicine, Pain Medicine
(Licence: AZ  55528)
Enumeration Date2013-09-20
Last Update Date2022-09-27
Business Address
Dr. JACK DIEP MD
1791 MESQUITE AVE
LAKE HAVASU CITY, AZ 86403-5648
Phone number: 928-505-5555
Mailing Address
Dr. JACK DIEP MD
25 RIVIERA BLVD
LAKE HAVASU CITY, AZ 86403-5694
Phone number: 928-505-5555