Provider Demographics
NPI:1194795583
Name:RHODEN, DIANE HARDING (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:HARDING
Last Name:RHODEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:EVE
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 504
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-1579
Practice Address - Fax:941-917-4340
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23599208600000X
ARE4479208600000X
FLME107490208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006498800Medicaid
FL33181OtherBCBS
OK200019600BMedicaid
0705003330OtherQUALCHOICE
5N779OtherBCBS
P00387238OtherRAILROAD MEDICARE
5N779OtherBCBS
FL006498800Medicaid