Provider Demographics
NPI:1699784587
Name:DIEFFENBACH, LOUIS A (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:A
Last Name:DIEFFENBACH
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 1:13215 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5054
Mailing Address - Country:US
Mailing Address - Phone:352-683-0232
Mailing Address - Fax:352-683-0247
Practice Address - Street 1:13215 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5054
Practice Address - Country:US
Practice Address - Phone:352-683-0232
Practice Address - Fax:352-683-0247
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55252207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593287415OtherOBGYN