Healthcare Provider Details

I. General information

NPI: 1659319069
Provider Name (Legal Business Name): DUANE MICHAEL DIAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98 ATTEN. SARP
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

840 AMBERWOOD DR
PENSACOLA FL
32506-7611
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-6776
  • Fax: 850-452-6025
Mailing address:
  • Phone: 850-458-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 305
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: