NPI | 1205943164 |
---|---|
Former Legal Business Name | DIANE A. HAISTEN, DO, LLC |
Entity Type | Organization |
Authorized Contact | DIANE A SCHLICK Proprieter 850-584-5876 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS7860) |
Enumeration Date | 2006-08-24 |
Last Update Date | 2007-08-02 |