Provider Demographics
NPI:1346214343
Name:WERTH, DIANE K (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:WERTH
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:PO BOX 3128
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-3128
Mailing Address - Country:US
Mailing Address - Phone:712-239-4702
Mailing Address - Fax:712-239-0616
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1394
Practice Address - Country:US
Practice Address - Phone:712-239-4702
Practice Address - Fax:712-239-0616
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25877207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41023Medicare PIN
IA410200002Medicare PIN
A03460Medicare UPIN