Provider Demographics
NPI:1023088945
Name:BREYER, DIANA M (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:BREYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:MAHURIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 E HARMONY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3400
Mailing Address - Country:US
Mailing Address - Phone:970-224-9102
Mailing Address - Fax:970-224-9112
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3400
Practice Address - Country:US
Practice Address - Phone:970-224-9102
Practice Address - Fax:970-224-9112
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0037818207RC0200X, 207RP1001X, 207R00000X
CO37818207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17584281Medicaid
WY114261500Medicaid
CO290012386OtherRAILROAD MEDICARE
CO268240YLB8Medicare PIN
CO290012386OtherRAILROAD MEDICARE
CO17584281Medicaid