Healthcare Provider Details

I. General information

NPI: 1851507446
Provider Name (Legal Business Name): DIANE CLAWSON, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19841 N 27TH AVE STE 302
PHOENIX AZ
85027-4006
US

IV. Provider business mailing address

19841 N 27TH AVE STE 302
PHOENIX AZ
85027-4006
US

V. Phone/Fax

Practice location:
  • Phone: 623-580-1144
  • Fax:
Mailing address:
  • Phone: 623-580-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number3516
License Number StateAZ

VIII. Authorized Official

Name: DIANE CLAWSON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 623-580-1144