Healthcare Provider Details

I. General information

NPI: 1902007560
Provider Name (Legal Business Name): DIANE G VANMAELE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 SCRIPTURE ST
DENTON TX
76201-4317
US

IV. Provider business mailing address

PO BOX 99371
FORT WORTH TX
76199-0371
US

V. Phone/Fax

Practice location:
  • Phone: 940-898-1477
  • Fax: 940-382-4091
Mailing address:
  • Phone: 682-885-1855
  • Fax: 682-885-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM6928
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: