Healthcare Provider Details

I. General information

NPI: 1336366624
Provider Name (Legal Business Name): ALEJANDRO ABEL DIAZ JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 S ALEXANDER ST
PLANT CITY FL
33563-8411
US

IV. Provider business mailing address

1706 S ALEXANDER ST
PLANT CITY FL
33563-8411
US

V. Phone/Fax

Practice location:
  • Phone: 813-717-9000
  • Fax:
Mailing address:
  • Phone: 813-717-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME100243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: