MEDICARE: MICHAEL J DIAMOND 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	P4565	TX
2	207Q00000X	Family Medicine Physician	E-6832	AR

General Provider Information

NPI Number	:	1679735625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J DIAMOND M D

Provider Business Mailing Address
First Line	:	5004 AVENUE F
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-2521
Country	:	US
Telephone Number	:	214-536-6416
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 HOSPITAL DR
Second Line	:
City	:	CARRIZO SPRINGS
State	:	TX
Zip	:	78834-3836
Country	:	US
Telephone Number	:	830-876-2424
Fax Number	:

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

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	11/22/2012

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