Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Jack Diep, MD

Individual provider Pain Medicine (Anesthesiology) Physician · NPI 1912333014

Dr. Jack Diep, MD is a Pain Management in Lake Havasu City, Arizona. Qualified in 2013, 13 years ago. Practices with Lakeside Orthopedic Institute LLC, a 13-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
13
Licensed in
AZ
In the registry since
2013
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1791 Mesquite Ave
Lake Havasu City, AZ 86403-5648
Phone: (928) 505-5555
Fax: (928) 505-2877
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 25 Riviera Blvd, Lake Havasu City, AZ 86403-5694 — (928) 505-5555

Specialties & licences

Interventional Pain Medicine Physician (primary) Taxonomy 208VP0014X · Licence 55528 (AZ)
Pain Medicine (Anesthesiology) Physician Taxonomy 207LP2900X · Licence 55528 (AZ)
Pain Medicine Physician Taxonomy 208VP0000X · Licence 55528 (AZ)

Record details

NPI number1912333014
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedSeptember 20, 2013
Last updated in NPPESSeptember 27, 2022
Certification dateSeptember 27, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPAIN MANAGEMENT
Also practisesANESTHESIOLOGY, INTERVENTIONAL PAIN MANAGEMENT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Lakeside Orthopedic Institute Llc — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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