MEDICARE: DR. DIANE E. GILLES M.D.

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	207X00000X	Orthopaedic Surgery Physician	18133	NE

General Provider Information

NPI Number	:	1740399468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE E. GILLES M.D.

Provider Business Mailing Address
First Line	:	1313 S ST
Second Line	:
City	:	BRIDGEPORT
State	:	NE
Zip	:	69336-2563
Country	:	US
Telephone Number	:	308-262-1616
Fax Number	:	308-262-0843

Provider Business Practice Location Address
First Line	:	1313 S ST
Second Line	:
City	:	BRIDGEPORT
State	:	NE
Zip	:	69336-2563
Country	:	US
Telephone Number	:	308-262-1616
Fax Number	:	308-262-0843

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	10/08/2013

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