Provider Demographics
NPI:1578745345
Name:DARBY, DIAN (L AC MSOM)
Entity Type:Individual
Prefix:
First Name:DIAN
Middle Name:
Last Name:DARBY
Suffix:
Gender:F
Credentials:L AC MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 ALEXIS CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3201
Mailing Address - Country:US
Mailing Address - Phone:512-389-3763
Mailing Address - Fax:
Practice Address - Street 1:5412 ALEXIS CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3201
Practice Address - Country:US
Practice Address - Phone:512-389-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist