Provider Demographics
NPI:1154471613
Name:HARRIS, DIANA CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CRAIG
Last Name:HARRIS
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 1:2441 N 9TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-3911
Mailing Address - Country:US
Mailing Address - Phone:850-434-9992
Mailing Address - Fax:850-435-2525
Practice Address - Street 1:2441 N 9TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-3911
Practice Address - Country:US
Practice Address - Phone:850-434-9992
Practice Address - Fax:850-435-2525
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0035426207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59002338OtherAL BC BS
FL3206905OtherUNITED HEALTHCARE
FLD53284Medicare UPIN
FL17444ZMedicare ID - Type Unspecified