Provider Demographics
NPI:1780766634
Name:WHITNEY, DIANE F (M D)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 SW MORRISON ST.
Mailing Address - Street 2:SUITE 525
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2224
Mailing Address - Country:US
Mailing Address - Phone:503-223-6360
Mailing Address - Fax:503-497-1257
Practice Address - Street 1:1220 SW MORRISON ST
Practice Address - Street 2:SUITE 525
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2224
Practice Address - Country:US
Practice Address - Phone:503-223-6360
Practice Address - Fax:503-497-1257
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 109742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC94563Medicare UPIN
OR0000BHKTWMedicare ID - Type Unspecified