Provider Demographics
NPI:1831148881
Name:CLAWSON, DIANE C (DO)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:C
Last Name:CLAWSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:UNM CHILDRENS PSYCHIATRIC CTR
Practice Address - Street 2:1001 YALE BLVD. NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-2890
Practice Address - Fax:505-272-1943
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMA-1182-02208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z114884Medicare PIN
H79216Medicare UPIN