Provider Demographics
NPI:1851507446
Name:DIANE CLAWSON, D.O., P.C.
Entity Type:Organization
Organization Name:DIANE CLAWSON, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-580-1144
Mailing Address - Street 1:19841 N 27TH AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4006
Mailing Address - Country:US
Mailing Address - Phone:623-580-1144
Mailing Address - Fax:
Practice Address - Street 1:19841 N 27TH AVE STE 302
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4006
Practice Address - Country:US
Practice Address - Phone:623-580-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3516204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79216Medicare UPIN
AZZ114883Medicare PIN