Healthcare Provider Details

I. General information

NPI: 1902043771
Provider Name (Legal Business Name): EDUARDO RAMON DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 ORIENTA AVE
ALTAMONTE SPRINGS FL
32701-5603
US

IV. Provider business mailing address

PO BOX 2153 DEPT 40339
BIRMINGHAM AL
35287-9387
US

V. Phone/Fax

Practice location:
  • Phone: 407-260-0166
  • Fax: 407-544-2028
Mailing address:
  • Phone: 706-271-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME103393
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME103393
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME103393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: