Provider Demographics
NPI:1376743492
Name:TIGANUS, DIANA (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:TIGANUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W MAIN ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4406
Mailing Address - Country:US
Mailing Address - Phone:360-666-3900
Mailing Address - Fax:360-666-3901
Practice Address - Street 1:720 W MAIN ST
Practice Address - Street 2:SUITE 115
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4406
Practice Address - Country:US
Practice Address - Phone:360-666-3900
Practice Address - Fax:360-666-3901
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60056472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8547770Medicaid
WA8547770Medicaid