Provider Demographics
NPI:1104868397
Name:SPEEDLING, DIANE D (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:D
Last Name:SPEEDLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5935
Mailing Address - Country:US
Mailing Address - Phone:850-478-1312
Mailing Address - Fax:850-474-9060
Practice Address - Street 1:36500 EMERALD COAST PKWY
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4713
Practice Address - Country:US
Practice Address - Phone:850-269-0301
Practice Address - Fax:850-269-0203
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88886207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268326100Medicaid
FL82233OtherBLUE CROSS BLUE SHIELD
AL592-10250OtherBLUE CROSS BLUE SHIELD
FLP00802932OtherMEDICARE RAILROAD
H99217Medicare UPIN
AL592-10250OtherBLUE CROSS BLUE SHIELD
FLU1802YMedicare PIN