Basic Information
| Provider Information | |||||||||
| NPI: | 1750425385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIERINGER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 SOUTH DRIVE | ||||||||
| Address2: | HARTSHORN HEALTH SERVICE COLORADO STATE UNIVERSITY | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704911707 | ||||||||
| FaxNumber: | 9704913560 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 SOUTH DRIVE | ||||||||
| Address2: | HARTSHORN HEALTH SERVICE COLORADO STATE UNIVERSITY | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704911707 | ||||||||
| FaxNumber: | 9704913560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 06/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 24348 | CO | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207Q00000X | 24348 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 24348 | CO | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.