Provider Demographics
NPI:1972678019
Name:MAYER, DIANE S (MD)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:S
Last Name:MAYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:STOUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:720 CALHOUN STREET
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118
Mailing Address - Country:US
Mailing Address - Phone:504-237-6848
Mailing Address - Fax:
Practice Address - Street 1:3941 HOUMA BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2920
Practice Address - Country:US
Practice Address - Phone:504-456-9199
Practice Address - Fax:504-456-9602
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017304208100000X
LAMD.017304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1333981Medicaid
LA1333981Medicaid
B65638Medicare UPIN