Provider Demographics
NPI:1861459224
Name:JUILLARD, DIANE ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:ELIZABETH
Last Name:JUILLARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2479
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85358-2479
Mailing Address - Country:US
Mailing Address - Phone:928-684-2874
Mailing Address - Fax:928-684-3151
Practice Address - Street 1:490 W BRALLIAR RD
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2448
Practice Address - Country:US
Practice Address - Phone:928-684-2874
Practice Address - Fax:928-684-3151
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD47228Medicare UPIN