Provider Demographics
NPI:1891734448
Name:BAIRD, DIANE L (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:L
Last Name:BAIRD
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 10605
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-2605
Mailing Address - Country:US
Mailing Address - Phone:541-683-3202
Mailing Address - Fax:641-868-1063
Practice Address - Street 1:360 S.GARDEN WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-683-3202
Practice Address - Fax:541-868-1063
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19050207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR128152Medicaid
07WFBFRAMedicare ID - Type Unspecified
OR128152Medicaid