Provider Demographics
NPI:1245566181
Name:ADAMS, DIANNE ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:ELIZABETH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2111 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-2085
Mailing Address - Country:US
Mailing Address - Phone:618-943-7421
Mailing Address - Fax:907-733-1735
Practice Address - Street 1:2111 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2085
Practice Address - Country:US
Practice Address - Phone:618-943-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5006207Q00000X, 207QS0010X
KY03569207Q00000X
AK169535207Q00000X
IL036.163171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine