Healthcare Provider Details

I. General information

NPI: 1093937815
Provider Name (Legal Business Name): ERIK DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 HERSCHEL ST
JACKSONVILLE FL
32204-3819
US

IV. Provider business mailing address

PO BOX 2295
ASHEVILLE NC
28802-2295
US

V. Phone/Fax

Practice location:
  • Phone: 904-381-9808
  • Fax:
Mailing address:
  • Phone: 828-398-5244
  • Fax: 828-360-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME105439
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: