Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JACKSON RAY DIEDE, MAT, ATC
ActiveJACKSON RAY DIEDE, MAT, ATC is a Sports Medicine (PM&R) healthcare provider located in SIOUX FALLS, South Dakota. NPI 1760054373 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine (PM&R) · SIOUX FALLS, SD
Registration Details
- NPI Number
- 1760054373
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 13, 2021 (5.1254064297064 yrs)
- Last Updated
- Jul 13, 2021
- License
-
0714 (SD)
Practice Information
- Address
-
810 E 23RD STSIOUX FALLS, SD, 571052135Browse SD providers · Browse ZIP 57105
- Phone
- 6053315890
- Primary Specialty
-
Sports Medicine (PM&R)
2081S0010X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.