MEDICARE: DR. ESMERALDO DIAZ HERRERA MD

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	207P00000X	Emergency Medicine Physician	25806	TN
2	207R00000X	Internal Medicine Physician	25806	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174501597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESMERALDO DIAZ HERRERA MD

Provider Business Mailing Address
First Line	:	101 JV MANGUBAT DR
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-2440
Country	:	US
Telephone Number	:	931-722-9999
Fax Number	:	931-722-2049

Provider Business Practice Location Address
First Line	:	101 JV MANGUBAT DR
Second Line	:
City	:	WAYNESBORO
State	:	TN
Zip	:	38485-2440
Country	:	US
Telephone Number	:	931-722-9999
Fax Number	:	931-722-2049

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	07/10/2019

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Directions to “ DR. ESMERALDO DIAZ HERRERA MD” Practice Location

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