Healthcare Provider Details

I. General information

NPI: 1952353807
Provider Name (Legal Business Name): DIANA BETH KOSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8328 E. HARTFORD DR.
SCOTTSDALE AZ
85255
US

IV. Provider business mailing address

8328 E. HARTFORD DR.
SCOTTSDALE AZ
85255
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-9720
  • Fax: 480-214-9722
Mailing address:
  • Phone: 480-214-9720
  • Fax: 480-214-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number29375
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29375
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: