MEDICARE: MS. DEBRA E DIEMAND

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770702425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA E DIEMAND

Provider Business Mailing Address
First Line	:	1415 SOUND RETREAT DR
Second Line	:
City	:	NAVARRE
State	:	FL
Zip	:	32566-7414
Country	:	US
Telephone Number	:	850-939-8896
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 TRUXTON AVE
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-2460
Country	:	US
Telephone Number	:	850-863-1530
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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