Individual
DR. DIANE DIERDRE DALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6119 W JEFFERSON BLVD, FORT WAYNE, IN 46804-3072
(260) 432-1568
(260) 432-4969
Mailing address
6119 W JEFFERSON BLVD, FORT WAYNE, IN 46804-3072
(260) 432-1568
(260) 432-4969
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01033743
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0787260
—
OH
05
—
100348560
—
IN
01
—
300016185
MEDICARE RAILROAD
IN
01
—
300077574
MEDICARE RAILROAD
IN
Enumeration date
01/27/2006
Last updated
12/16/2009
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