Provider Demographics
NPI:1356515217
Name:VAN DIEST, EILEEN ELISABETH (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:ELISABETH
Last Name:VAN DIEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EILEEN
Other - Middle Name:ELISABETH
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:32685 US HIGHWAY 281 N STE 181
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-3271
Mailing Address - Country:US
Mailing Address - Phone:830-219-4162
Mailing Address - Fax:830-310-7974
Practice Address - Street 1:179 ENTERPRISE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8634
Practice Address - Country:US
Practice Address - Phone:830-219-4162
Practice Address - Fax:830-310-7974
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7978207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine