Provider Demographics
NPI:1184643306
Name:HEARD, DIANA DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:DENISE
Last Name:HEARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:DENISE
Other - Last Name:HEARD-VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5750 W THUNDERBIRD ROAD
Mailing Address - Street 2:SUITE D400
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-298-8977
Mailing Address - Fax:602-298-1787
Practice Address - Street 1:5750 W THUNDERBIRD ROAD
Practice Address - Street 2:SUITE D400
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-298-8977
Practice Address - Fax:602-298-1787
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079540207V00000X
AZ40357207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ344649Medicaid