Provider Demographics
NPI:1316938079
Name:DIEL, KEVIN RAY (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:RAY
Last Name:DIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 US HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-3520
Mailing Address - Country:US
Mailing Address - Phone:334-493-4357
Mailing Address - Fax:334-222-3825
Practice Address - Street 1:1800 US HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-3520
Practice Address - Country:US
Practice Address - Phone:334-493-4357
Practice Address - Fax:334-222-3825
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004010176208D00000X
AL30614208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I016582OtherMEDICARE PTAN
AL127794Medicaid