Provider Demographics
NPI:1386628808
Name:REGGIARDO, DIANA B (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:B
Last Name:REGGIARDO
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6300 HARRY HINES BLVD # 110
Practice Address - Street 2:PEDIATRICS PRIMARY CARE CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5259
Practice Address - Country:US
Practice Address - Phone:214-266-0100
Practice Address - Fax:214-266-0113
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119089405Medicaid
TX119089409Medicaid
TX119089412Medicaid
TX119089414Medicaid
TX119089416Medicaid
TX119089418Medicaid
TX119089415Medicaid
TX119089403Medicaid
TX119089408Medicaid
TX119089417Medicaid
TX119089411Medicaid
TX84679FOtherBLUE CROSS BLUE SHIELD
TX119089419Medicaid
TX119089422Medicaid
TX119089412Medicaid
TX119089416Medicaid