Provider Demographics
NPI:1033143151
Name:ZHAO, DIANE D (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:D
Last Name:ZHAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:DONGYAN
Other - Middle Name:
Other - Last Name:ZHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14509 UNIVERSITY POINT PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-5424
Mailing Address - Country:US
Mailing Address - Phone:813-910-1606
Mailing Address - Fax:813-866-4919
Practice Address - Street 1:14509 UNIVERSITY POINT PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-5424
Practice Address - Country:US
Practice Address - Phone:813-910-1606
Practice Address - Fax:813-866-4919
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85222208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1033143151OtherNPI
FL17070YOtherMEDICARE ID