Provider Demographics
NPI:1952536336
Name:JUAREZ, DIANNA (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 S RIFE MEDICAL LN
Mailing Address - Street 2:STE T40
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1474
Mailing Address - Country:US
Mailing Address - Phone:903-439-4917
Mailing Address - Fax:903-885-1329
Practice Address - Street 1:113 AIRPORT RD STE 200
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2193
Practice Address - Country:US
Practice Address - Phone:903-439-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9906207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323252201Medicaid
TX323252201Medicaid