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General NPI Number Information
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NPI Number | 1558693192
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Entity Type | Organization
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Legal Business Name | HEBE DIAZ M.D. PLLC
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 1720A MEDICAL PARK DR SUITE 130C
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City | BILOXI
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State | MS
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Zip | 39532-2129
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Country | US
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Telephone | 228-392-8881
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Fax | 228-392-8887
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Provider Business Mailing Address
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Address Line | 1720A MEDICAL PARK DR SUITE 130C
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City | BILOXI
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State | MS
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Zip | 39532-2129
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Country | US
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Telephone | 228-392-8881
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Fax | 228-392-8887
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MS. JUDY L JARRELL
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Credential |
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Telephone | 228-392-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 19018
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License Number State | MS
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