Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME100243 | FL |
NPI | 1336366624 |
---|---|
Provider Name | Dr. Alejandro Abel Diaz JR. |
First Address | Plant City, FL 33563-8411 |
Second Address | Plant City, FL 33563-8411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 28/01/2013 |