MEDICARE: JEFFREY DAVID DIEBNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	J4086	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83R238	OTHER	TX	COLLIN COUNTY PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073571758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DAVID DIEBNER MD

Provider Business Mailing Address
First Line	:	1820 PRESTON PARK BLVD
Second Line	:	1825
City	:	PLANO
State	:	TX
Zip	:	75093-3656
Country	:	US
Telephone Number	:	972-867-7862
Fax Number	:	972-612-1623

Provider Business Practice Location Address
First Line	:	6200 W PARKER RD
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7939
Country	:	US
Telephone Number	:	972-608-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	05/11/2016

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