Healthcare Provider Details

I. General information

NPI: 1699157180
Provider Name (Legal Business Name): JORGE B DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S PARSONS AVE
BRANDON FL
33511-6058
US

IV. Provider business mailing address

731 S PARSONS AVE
BRANDON FL
33511-6058
US

V. Phone/Fax

Practice location:
  • Phone: 813-499-1500
  • Fax: 813-499-1499
Mailing address:
  • Phone: 813-499-1500
  • Fax: 813-499-1499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: