Healthcare Provider Details

I. General information

NPI: 1235184805
Provider Name (Legal Business Name): EDUARDO DIEGUEZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 STATE ROAD 206 E STE 1
ST AUGUSTINE FL
32086-4869
US

IV. Provider business mailing address

PO BOX 3105
ST AUGUSTINE FL
32085-3105
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-0955
  • Fax: 904-824-2226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME41955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: