Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 243600 | NY |
Y | 207VX0201X | Gynecologic Oncologist | ME108148 | FL |
NPI | 1578719167 |
---|---|
Provider Name | John Paul Diaz |
First Address | Atlanta, GA 30374-2057 |
Second Address | Miami, FL 33176-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2008 |
Last Update Date | 16/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002712200 | (05) | FL |