MEDICARE: IVAN DIAZ 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	ME94841	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01315667	OTHER	FL	RAILROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972575389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN DIAZ MD

Provider Business Mailing Address
First Line	:	5350 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4562
Country	:	US
Telephone Number	:	352-277-5348
Fax Number	:	352-606-2857

Provider Business Practice Location Address
First Line	:	10200 YALE AVE
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34613-8375
Country	:	US
Telephone Number	:	352-597-1960
Fax Number	:	352-597-9470

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	04/08/2026

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Directions to “ IVAN DIAZ MD” Practice Location

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