Provider Demographics
NPI:1831149020
Name:DIAMOND, ALAN L (DO)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:L
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:12 E APPLEBY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3901
Mailing Address - Country:US
Mailing Address - Phone:479-463-4444
Mailing Address - Fax:479-463-4499
Practice Address - Street 1:12 E APPLEBY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3901
Practice Address - Country:US
Practice Address - Phone:479-463-4444
Practice Address - Fax:479-463-4499
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-04-22
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Provider Licenses
StateLicense IDTaxonomies
ARE-44372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160294003Medicaid
AR160294003Medicaid
COI39979Medicare UPIN