Healthcare Provider Details

I. General information

NPI: 1376598623
Provider Name (Legal Business Name): ERNESTO R DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 SE FEDERAL HWY STE 973B
STUART FL
34994-3702
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-5897
  • Fax:
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 90000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: