Provider Demographics
NPI:1023098696
Name:EODICE, DIANE M (DO)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:EODICE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 NORTH MONTANA AVENUE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4926
Mailing Address - Country:US
Mailing Address - Phone:406-443-7733
Mailing Address - Fax:406-443-8292
Practice Address - Street 1:820 N MONTANA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3856
Practice Address - Country:US
Practice Address - Phone:406-443-7733
Practice Address - Fax:406-443-8292
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0092667Medicaid
MT0098935OtherBCBS
MT0098935OtherBCBS
MT000084368Medicare ID - Type Unspecified