Provider Demographics
NPI:1164465688
Name:DIAMOND, KENNETH L (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:DIAMOND
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 1:18123 E MASSAI POINT DR
Mailing Address - Street 2:
Mailing Address - City:RIO VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85263-0023
Mailing Address - Country:US
Mailing Address - Phone:954-554-5904
Mailing Address - Fax:
Practice Address - Street 1:2400 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7127
Practice Address - Country:US
Practice Address - Phone:928-336-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47970207RG0100X
OH35.144478207RG0100X
IL036-067677207RG0100X
AZ70105207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048885200Medicaid
FL03808YMedicare PIN
FL048885200Medicaid