1235446741 NPI number — DR. WALTER FRANCIS DIAK III PH.D.

Table of content: DR. WALTER FRANCIS DIAK III PH.D. (NPI 1235446741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235446741 NPI number — DR. WALTER FRANCIS DIAK III PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAK
Provider First Name:
WALTER
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIAK III
Provider Other First Name:
WALTER
Provider Other Middle Name:
F
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235446741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28870 US 19 N
Provider Second Line Business Mailing Address:
SUITE 357
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33761-2596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-280-6569
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28870 US 19 N
Provider Second Line Business Practice Location Address:
SUITE 357
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33761-2596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-280-6569
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  PY 8129 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com