Provider Demographics
NPI:1225005762
Name:DOERNER, DIANE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DOERNER
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 1:1909 214TH ST SE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4412
Mailing Address - Country:US
Mailing Address - Phone:425-420-1648
Mailing Address - Fax:425-420-1649
Practice Address - Street 1:1909 214TH ST SE
Practice Address - Street 2:SUITE 211
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4412
Practice Address - Country:US
Practice Address - Phone:425-420-1648
Practice Address - Fax:425-420-1649
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8194698Medicaid
WA8853585Medicare ID - Type Unspecified
WA8194698Medicaid