Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 8643 | PR |
Y | 208D00000X | General Practice Physician | ME122262 | FL |
NPI | 1497792162 |
---|---|
Provider Name | Jose M Diaz |
First Address | Land O Lakes, FL 34639-5420 |
Second Address | Tampa, FL 33625-5800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 12/11/2019 |