Provider Demographics
NPI:1487747564
Name:HUSTON, DIANA A (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:A
Last Name:HUSTON
Suffix:
Gender:F
Credentials:MD
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 99406
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0406
Mailing Address - Country:US
Mailing Address - Phone:817-605-2833
Mailing Address - Fax:682-885-3939
Practice Address - Street 1:6316 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2766
Practice Address - Country:US
Practice Address - Phone:817-605-2500
Practice Address - Fax:817-605-2983
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1003887985OtherGRP NPI NUMBER
TX10022305OtherAMERIGROUP PIN
TX160429004Medicaid
TX5687156OtherAETNA PIN
TX8M3072OtherBCBSTX IND PIN
TX160429003Medicaid
TX008YLEOtherBCBSTX GRP PIN
TX1861990OtherCIGNA PIN
TX080626701Medicaid
TX114571OtherSUPERIOR PIN
TX1633114101Medicaid
TN2146961OtherFIRSTHEALTH PIN
TX160429003Medicaid