Healthcare Provider Details

I. General information

NPI: 1225001712
Provider Name (Legal Business Name): DENNIS D DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST DEPT. OTOLARYNGOLOGY
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

14001 FAIRWINDS CT
ORLANDO FL
32824-5272
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-1599
  • Fax:
Mailing address:
  • Phone: 541-912-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD24299
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: