Provider Demographics
NPI:1346347812
Name:DIAMOND, RENE E (DO)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:E
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2710 S RIFE MEDICAL LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1452
Mailing Address - Country:US
Mailing Address - Phone:479-338-8000
Mailing Address - Fax:479-338-2383
Practice Address - Street 1:2710 S RIFE MEDICAL LN
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1452
Practice Address - Country:US
Practice Address - Phone:479-338-8000
Practice Address - Fax:479-338-2383
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168209003Medicaid
BD9896551OtherFEDERAL DEA
AR5H078Medicare PIN
ARE5378OtherMED LIC