Provider Demographics
NPI:1669668273
Name:DIAMOND FAMILY MEDICINE PLLC DONITA KAY DIAMOND SOLE MBR
Entity Type:Organization
Organization Name:DIAMOND FAMILY MEDICINE PLLC DONITA KAY DIAMOND SOLE MBR
Other - Org Name:DIAMOND MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONITA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-416-1190
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:TERRA CEIA
Mailing Address - State:FL
Mailing Address - Zip Code:34250-0053
Mailing Address - Country:US
Mailing Address - Phone:941-416-1190
Mailing Address - Fax:
Practice Address - Street 1:102 RIVIERA DUNES WAY
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221
Practice Address - Country:US
Practice Address - Phone:941-416-1190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 13024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty