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General NPI Number Information
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NPI Number | 1790997609
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Entity Type | Organization
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Legal Business Name | R DIAZ MD LLC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 4 BY PASS RD SUITE 203
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City | SALEM
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State | NJ
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Zip | 08079-2053
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Country | US
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Telephone | 856-339-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 4 BY PASS RD SUITE 203
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City | SALEM
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State | NJ
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Zip | 08079-2053
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Country | US
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Telephone | 856-339-4444
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | ROBERTO R DIAZ
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Credential | M.D.
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Telephone | 865-339-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA0310550
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License Number State | NJ
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