Provider Demographics
NPI:1811969801
Name:KOALA, DIANA K (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:KOALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:GIBFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 MADISON ST
Mailing Address - Street 2:SUITE 950
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3592
Mailing Address - Country:US
Mailing Address - Phone:206-682-5800
Mailing Address - Fax:206-233-9657
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:SUITE 950
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3592
Practice Address - Country:US
Practice Address - Phone:206-682-5800
Practice Address - Fax:206-233-9657
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7086887Medicaid
WA7086887Medicaid