MEDICARE: DR. GERARDO 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	208D00000X	General Practice Physician	ME103459	FL
2	208000000X	Pediatrics Physician	ME 103459	FL

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	:	1235370289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARDO DIAZ M.D

Provider Business Mailing Address
First Line	:	22112 SW 130TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33170-2694
Country	:	US
Telephone Number	:	305-978-6309
Fax Number	:

Provider Business Practice Location Address
First Line	:	14201 S DIXIE HWY
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33176-7224
Country	:	US
Telephone Number	:	786-227-6396
Fax Number	:	786-227-6456

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

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	10/30/2023

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Directions to “ DR. GERARDO DIAZ M.D” Practice Location

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