Provider Demographics
NPI:1528069671
Name:DIAMOND, DAVID ADAM (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ADAM
Last Name:DIAMOND
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 1:483 N SEMORAN BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-539-0722
Mailing Address - Fax:407-539-0723
Practice Address - Street 1:483 N SEMORAN BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3800
Practice Address - Country:US
Practice Address - Phone:407-539-0722
Practice Address - Fax:407-539-0723
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME783502085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIN463XOtherMEDICARE PTAN
FLK9074OtherMEDICARE PTAN
FL257078500Medicaid
FL257078500Medicaid
FL46730Medicare ID - Type Unspecified