Healthcare Provider Details

I. General information

NPI: 1184643306
Provider Name (Legal Business Name): DIANA DENISE HEARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA DENISE HEARD-VAUGHN MD

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD ROAD SUITE D400
GLENDALE AZ
85306
US

IV. Provider business mailing address

5750 W THUNDERBIRD ROAD SUITE D400
GLENDALE AZ
85306
US

V. Phone/Fax

Practice location:
  • Phone: 602-298-8977
  • Fax: 602-298-1787
Mailing address:
  • Phone: 602-298-8977
  • Fax: 602-298-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301079540
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number40357
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: