MEDICARE: JOSE M 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	207ZP0101X	Anatomic Pathology Physician	8643	PR
2	207U00000X	Nuclear Medicine Physician	8643	PR
3	2085U0001X	Diagnostic Ultrasound Physician	8643	PR
4	208D00000X	General Practice Physician	ME122262	FL

General Provider Information

NPI Number	:	1497792162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE M DIAZ M.D

Provider Business Mailing Address
First Line	:	2347 TIOGA DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-5420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6904 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-5800
Country	:	US
Telephone Number	:	813-888-7710
Fax Number	:

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	11/12/2019

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