Wayne Diedrick, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA3021 Issued in FL

Practice address

3501 Johnson St
Hollywood, FL 33021-5421

Phone

(954) 987-2020

NPI assigned

Aug 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083626386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 862233",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328862233",
            "telephone_number": "954-276-5575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 JOHNSON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215421",
            "telephone_number": "954-987-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEDRICK",
        "first_name": "WAYNE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA3021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher A Dicarlo, DC
• Alyssa Dickens, PT
• Anne E Dickison, MD
• Franco A Dickson, PHARMD
• Christopher M. Didonato, D.O.
• Janette Beatriz Dieguez, PA-C
• Katherine Marie Dierker, RN
• Anne Grethe Difini
• Digestive & Liver Disease Consultants of South Florida PA
• Digestive Anesthesia Services PA

• Surgical Physician Assistant in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.