Provider Demographics
NPI:1235844432
Name:DIANE T SERVOSS MD PLLC
Entity Type:Organization
Organization Name:DIANE T SERVOSS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:SERVOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-780-1055
Mailing Address - Street 1:PO BOX 9017
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-9017
Mailing Address - Country:US
Mailing Address - Phone:520-780-1055
Mailing Address - Fax:
Practice Address - Street 1:7010 N JAVELINA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1850
Practice Address - Country:US
Practice Address - Phone:520-780-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104822Medicaid