MEDICARE: DIANNA MOSLEY BURNS 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	208000000X	Pediatrics Physician	G7179	TX

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	:	1972507861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNA MOSLEY BURNS M.D.

Provider Business Mailing Address
First Line	:	13750 SAN PEDRO AVE
Second Line	:	STE 560
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4375
Country	:	US
Telephone Number	:	210-561-3100
Fax Number	:	210-545-3076

Provider Business Practice Location Address
First Line	:	1954 E HOUSTON ST
Second Line	:	RM 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78202-2952
Country	:	US
Telephone Number	:	210-227-2100
Fax Number	:	210-227-1915

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/27/2012

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