Provider Demographics
NPI:1750370391
Name:WILLIAMS, DIANE C (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:19 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7337
Mailing Address - Country:US
Mailing Address - Phone:541-482-9741
Mailing Address - Fax:541-488-6141
Practice Address - Street 1:99 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1787
Practice Address - Country:US
Practice Address - Phone:541-482-9741
Practice Address - Fax:541-488-6141
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD103722080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC94083Medicare UPIN
ORR107649Medicare PIN