Individual
KATHLYN DIEFENDERFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
101 PROFESSIONAL LN, ENTERPRISE, AL 36330-2085
(334) 347-3404
(334) 393-0613
Mailing address
101 PROFESSIONAL LN, ENTERPRISE, AL 36330-2085
(334) 793-8087
(334) 393-0613
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
00023919
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009957070
—
AL
01
—
51502734
BLUE CROSS BLUE SHIELD
AL
Enumeration date
07/24/2006
Last updated
11/09/2007
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