Provider Demographics
NPI:1922149343
Name:SALZBURG, DIANA LYNNE (LM)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNNE
Last Name:SALZBURG
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 NE 1ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5710
Mailing Address - Country:US
Mailing Address - Phone:352-377-3879
Mailing Address - Fax:352-478-0175
Practice Address - Street 1:521 NE 1ST ST STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5710
Practice Address - Country:US
Practice Address - Phone:352-377-3879
Practice Address - Fax:352-478-0175
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW20176B00000X
FLMW0020176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340428500Medicaid
FLY2945OtherBLUE CROSS BLUE SHIELD