Provider Demographics
NPI:1265436182
Name:DIEBEL, N DONALD SR (MD, PHD)
Entity type:Individual
Prefix:
First Name:N
Middle Name:DONALD
Last Name:DIEBEL
Suffix:SR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25317
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-5317
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:1551 CLAY ST
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5499
Practice Address - Country:US
Practice Address - Phone:407-644-5371
Practice Address - Fax:407-345-0856
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0030235207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48929YMedicare ID - Type Unspecified
FLD55516Medicare UPIN