MEDICARE: ISMAEL DIAZ JR. 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	207Q00000X	Family Medicine Physician	L3952	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1639230048	OTHER	TX	GROUP NPI

General Provider Information

NPI Number	:	1831187004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISMAEL DIAZ JR. MD

Provider Business Mailing Address
First Line	:	17903 WEST LAKE HOUSTON PARKWAY
Second Line	:	SUITE 201
City	:	HUMBLE
State	:	TX
Zip	:	77346-3882
Country	:	US
Telephone Number	:	281-812-1846
Fax Number	:	281-812-2778

Provider Business Practice Location Address
First Line	:	17903 WEST LAKE HOUSTON PARKWAY
Second Line	:	SUITE 201
City	:	HUMBLE
State	:	TX
Zip	:	77346-3882
Country	:	US
Telephone Number	:	281-812-1846
Fax Number	:	281-812-2778

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	06/15/2015

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