Provider Demographics
NPI:1003879313
Name:SHIPMAN, DIANA L (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:L
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2438 E FRONTIER ELM DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4948
Mailing Address - Country:US
Mailing Address - Phone:321-544-5060
Mailing Address - Fax:
Practice Address - Street 1:1100 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1944
Practice Address - Country:US
Practice Address - Phone:479-444-5093
Practice Address - Fax:479-587-6105
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1906207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2762211100Medicaid
TX156173001Medicaid
TX8A3128Medicare ID - Type Unspecified
FL2762211100Medicaid
TX156173001Medicaid