Provider Demographics
NPI:1912092339
Name:BOTELER, DIANE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LOUISE
Last Name:BOTELER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:ORCAS MEDICAL CENTER PLLC
Mailing Address - City:EASTSOUND
Mailing Address - State:WA
Mailing Address - Zip Code:98245-1269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 DEYE LANE
Practice Address - Street 2:ORCAS MEDICAL CENTER, PLLC
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-1269
Practice Address - Country:US
Practice Address - Phone:360-376-2561
Practice Address - Fax:360-376-5183
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00027712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF00254Medicare UPIN