Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN0013293 | FL |
NPI | 1003921099 |
---|---|
Provider Name | Dr. Marcos Diaz |
First Address | Weston, FL 33326-3249 |
Second Address | Weston, FL 33326-3249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U51539 | (02) | FL |