Provider Demographics
NPI:1144404955
Name:ROUKOZ, DIANA M (DO)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:ROUKOZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:SATER-ROUKOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3530 JEFFCO BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-6101
Mailing Address - Country:US
Mailing Address - Phone:314-467-3800
Mailing Address - Fax:
Practice Address - Street 1:3530 JEFFCO BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-6101
Practice Address - Country:US
Practice Address - Phone:314-467-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003017259208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics