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General NPI Number Information
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NPI Number | 1851587406
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Entity Type | Organization
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Legal Business Name | EDUARDO DIEGUEZ JR MD PA
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 811 STATE ROAD 206 E STE 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4869
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Country | US
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Telephone | 904-824-0955
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Fax | 904-824-2226
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Provider Business Mailing Address
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Address Line | PO BOX 3105
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-3105
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDUARDO DIEGUEZ JR.
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Credential | MD
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Telephone | 904-824-0955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME41955
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License Number State | FL
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