Provider Demographics
NPI:1063471910
Name:DIAMOND, DALTON EVAN (MD, MPH)
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:EVAN
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 PINE NEEDLE TRCE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-5804
Mailing Address - Country:US
Mailing Address - Phone:256-571-8923
Mailing Address - Fax:
Practice Address - Street 1:67 PINE NEEDLE TRCE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-5804
Practice Address - Country:US
Practice Address - Phone:256-571-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC72166Medicare UPIN