Basic Information
| Provider Information | |||||||||
| NPI: | 1285638239 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIENER | ||||||||
| FirstName: | HAAGEN | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2161 E. PECOS ROAD | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852256131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027532663 | ||||||||
| FaxNumber: | 4802472479 | ||||||||
| Practice Location | |||||||||
| Address1: | 2161 E. PECOS ROAD | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852256131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027532663 | ||||||||
| FaxNumber: | 4802472479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 29248 | AZ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 563016 | 05 | AZ | MEDICAID | AZ0884660 | 01 | AZ | BCBS | OTHER |