Provider Demographics
NPI:1740399468
Name:GILLES, DIANE E (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
Last Name:GILLES
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 1:1313 S ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NE
Mailing Address - Zip Code:69336-2563
Mailing Address - Country:US
Mailing Address - Phone:308-262-1616
Mailing Address - Fax:308-262-0843
Practice Address - Street 1:1313 S ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NE
Practice Address - Zip Code:69336-2563
Practice Address - Country:US
Practice Address - Phone:308-262-1616
Practice Address - Fax:308-262-0843
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18133207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE086022001Medicare PIN
NE088637Medicare PIN
E59437Medicare UPIN