Healthcare Provider Details

I. General information

NPI: 1508486549
Provider Name (Legal Business Name): DARIEL ANDRES DIAZ PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 NW 64TH TER
GAINESVILLE FL
32605-4218
US

IV. Provider business mailing address

1147 NW 64TH TER
GAINESVILLE FL
32605-4218
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5168
  • Fax:
Mailing address:
  • Phone: 352-333-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME36726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: