Healthcare Provider Details

I. General information

NPI: 1679786974
Provider Name (Legal Business Name): ROBERT PROCTOR DIAMOND M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7592 E PALO VERDE ST SUITE A
PRESCOTT VALLEY AZ
86314-3235
US

IV. Provider business mailing address

7592 E PALO VERDE ST SUITE A
PRESCOTT VALLEY AZ
86314-3235
US

V. Phone/Fax

Practice location:
  • Phone: 928-227-2900
  • Fax: 928-277-1494
Mailing address:
  • Phone: 928-227-2900
  • Fax: 928-277-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: