Healthcare Provider Details

I. General information

NPI: 1750447546
Provider Name (Legal Business Name): DIANE L BAIRD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S GARDEN WAY STE 210
EUGENE OR
97401-8186
US

IV. Provider business mailing address

360 S GARDEN WAY STE 210
EUGENE OR
97401-8186
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-3202
  • Fax: 541-868-1063
Mailing address:
  • Phone: 541-683-3202
  • Fax: 541-868-1063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDC9278
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerRAILROAD MEDICARE PIN

VIII. Authorized Official

Name: BREAUNA GERMYN
Title or Position: BILLER/CONTRACTING COORDINATOR
Credential:
Phone: 541-505-4134