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Provider Information for 1699157180

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. JORGE B DIAZ M.D.

Gender: MALE

Individual NPI: 1699157180

Calendar   Last Updated:  2019-03-28
  Certification Date: 

Details

Name Value
NPI 1699157180
Enumeration Date 2015-06-22
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 8011 N HIMES AVE STE 4
TAMPA, FL 33614-2700
United States

Phone: 813-488-1414 | Fax: 813-488-1413
View Map External Link
Primary Practice Address 8011 N HIMES AVE STE 4
TAMPA, FL 33614-2700
United States

Phone: 813-488-1414 | Fax: 813-488-1413
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other MEDICAL LICENSE FL ACN671
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 208D00000X - General Practice FL ACN671