MEDICARE: DAVID ALAN DIAZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	J1080	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J1080	OTHER	TX	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1033106380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALAN DIAZ M.D.

Provider Business Mailing Address
First Line	:	15930 S GREAT OAKS DR
Second Line	:	A-200
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5526
Country	:	US
Telephone Number	:	512-246-3338
Fax Number	:	512-246-3368

Provider Business Practice Location Address
First Line	:	15930 S GREAT OAKS DR
Second Line	:	A-200
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5526
Country	:	US
Telephone Number	:	512-246-3338
Fax Number	:	512-246-3368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	07/08/2007

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Directions to “ DAVID ALAN DIAZ M.D.” Practice Location

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