Healthcare Provider Details

I. General information

NPI: 1427161637
Provider Name (Legal Business Name): DIANNE E. WOLLASTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 FROSTWOOD SUITE 208
HOUSTON TX
77024-2426
US

IV. Provider business mailing address

902 FROSTWOOD SUITE 208
HOUSTON TX
77024-2426
US

V. Phone/Fax

Practice location:
  • Phone: 713-266-1946
  • Fax: 713-467-7432
Mailing address:
  • Phone: 713-266-1946
  • Fax: 713-467-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberJ6819
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: