Individual
DIANA MINASIAN STULC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(615) 377-5658
(888) 241-1404
Mailing address
5410 MARYLAND WAY 300, BRENTWOOD, TN 37072-5064
(615) 377-5658
(888) 241-1404
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20783
MS
207Q00000X
Family Medicine Physician
36090
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01139543
—
MS
05
—
64024268
—
KY
Enumeration date
02/16/2006
Last updated
12/21/2009
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