Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JACK DIEP, MD
ActiveDR. JACK DIEP, MD is a Interventional Vascular Surgery healthcare provider located in LAKE HAVASU CITY, Arizona. NPI 1912333014 is currently active in the NPPES registry. Verify at CMS.
Interventional Vascular Surgery · LAKE HAVASU CITY, AZ
Registration Details
- NPI Number
- 1912333014
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 20, 2013 (12.908781305318 yrs)
- Last Updated
- Sep 27, 2022
- Licenses
-
55528 (AZ)55528 (AZ)55528 (AZ)
Practice Information
- Address
-
1791 MESQUITE AVELAKE HAVASU CITY, AZ, 864035648Browse AZ providers · Browse ZIP 86403
- Phone
- 9285055555
- Fax
- 9285052877
- Primary Specialty
-
Interventional Vascular Surgery
208VP0014X
- Additional Specialty
- Vascular Surgery
- Additional Specialty
- Interventional Vascular Surgery
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.