Provider Demographics
NPI:1649381617
Name:DIEBOLD, CATHERINE M (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:DIEBOLD
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 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-448-1216
Mailing Address - Fax:985-446-8765
Practice Address - Street 1:506 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4862
Practice Address - Country:US
Practice Address - Phone:985-448-1216
Practice Address - Fax:985-446-8765
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11300R174400000X
LAMD.11300R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00062142OtherRAILROAD
LA5378010OtherAETNA PPO
LA1661481Medicaid
LA272804DOtherUNITED HEALTH CARE
LA272804DOtherUNITED HEALTH CARE
LA1661481Medicaid