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General NPI Number Information
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NPI Number | 1255448601
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Entity Type | Individual
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Provider Name | DIANA T. JUCAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 700 W GROVE ST
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City | EL DORADO
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State | AR
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Zip | 71730-4416
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Country | US
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Telephone | 870-862-1577
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Fax |
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Provider Business Mailing Address
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Address Line | 611 THOMPSON AVE P.O. BOX 506
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City | EL DORADO
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State | AR
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Zip | 71730-4557
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Country | US
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Telephone | 870-862-1577
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Fax | 870-862-5916
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C4290
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License Number State | AR
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