Provider Demographics
NPI:1083715437
Name:HALLMANN, DIANE S (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:S
Last Name:HALLMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:S
Other - Last Name:RISSANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4115 N LONGVALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442
Mailing Address - Country:US
Mailing Address - Phone:352-443-9020
Mailing Address - Fax:
Practice Address - Street 1:650 E INDIAN SCHOOL ROAD
Practice Address - Street 2:VA LOCUM TENENS PROGRAM
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-626-7468
Practice Address - Fax:602-761-5552
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040173-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine