Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | D72676 | MD |
Y | 2086S0127X | Trauma Surgeon | D72676 | MD |
NPI | 1144304262 |
---|---|
Provider Name | Jose J Diaz |
First Address | Baltimore, MD 21264-4793 |
Second Address | Baltimore, MD 21201-1544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 15/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0139 | BLUE CROSS (01) | MD |
559908300 | (05) | MD |
G01469 | (02) |