Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 25006 | TX |
NPI | 1477880227 |
---|---|
Provider Name | Dr. David Diaz Martinez |
First Address | Paris, TX 75460-5020 |
Second Address | Rockwall, TX 75032-6660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2009 |
Last Update Date | 09/12/2019 |