Provider Demographics
NPI:1730348467
Name:DIEKER, CARRIE ALISSA (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ALISSA
Last Name:DIEKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2530 S TELSHOR BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4951
Mailing Address - Country:US
Mailing Address - Phone:575-556-6400
Mailing Address - Fax:575-556-6405
Practice Address - Street 1:2530 S TELSHOR BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4951
Practice Address - Country:US
Practice Address - Phone:575-556-6400
Practice Address - Fax:575-556-6405
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2014-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP7425208600000X
NMMD2014-0801208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery