Healthcare Provider Details

I. General information

NPI: 1962908889
Provider Name (Legal Business Name): ALEXANDER KRISTIAN DIAZ MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MEDICAL CENTER DR
PADUCAH KY
42003-7912
US

IV. Provider business mailing address

1404 GARLAND CT
MURRAY KY
42071-9391
US

V. Phone/Fax

Practice location:
  • Phone: 270-441-4343
  • Fax:
Mailing address:
  • Phone: 678-773-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number58282
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: