Provider Demographics
NPI:1427161637
Name:WOLLASTON, DIANNE E (MD)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:E
Last Name:WOLLASTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:902 FROSTWOOD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2426
Mailing Address - Country:US
Mailing Address - Phone:713-266-1946
Mailing Address - Fax:713-467-7432
Practice Address - Street 1:902 FROSTWOOD
Practice Address - Street 2:SUITE 208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2426
Practice Address - Country:US
Practice Address - Phone:713-266-1946
Practice Address - Fax:713-467-7432
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6819207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31736Medicare UPIN
TX612225Medicare ID - Type Unspecified