Provider Demographics
NPI:1417064536
Name:WARREN, DIANA W (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:W
Last Name:WARREN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:42030 HIGHWAY 195 SUITE C
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-0880
Mailing Address - Country:US
Mailing Address - Phone:205-485-7337
Mailing Address - Fax:205-485-7393
Practice Address - Street 1:42030 HIGHWAY 195
Practice Address - Street 2:SUITE C
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565
Practice Address - Country:US
Practice Address - Phone:205-485-7337
Practice Address - Fax:205-485-7393
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO523207QA0401X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG75727Medicare UPIN
AL051516753Medicare ID - Type Unspecified