Basic Information
| Provider Information | |||||||||
| NPI: | 1184643306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEARD | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HEARD-VAUGHN | ||||||||
| OtherFirstName: | DIANA | ||||||||
| OtherMiddleName: | DENISE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5750 W THUNDERBIRD ROAD | ||||||||
| Address2: | SUITE D400 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022988977 | ||||||||
| FaxNumber: | 6022981787 | ||||||||
| Practice Location | |||||||||
| Address1: | 5750 W THUNDERBIRD ROAD | ||||||||
| Address2: | SUITE D400 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022988977 | ||||||||
| FaxNumber: | 6022981787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 12/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301079540 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 40357 | AZ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 344649 | 05 | AZ | MEDICAID |