MEDICARE: DR. FERNANDO N DIAZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME 0036602	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174699870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO N DIAZ MD

Provider Business Mailing Address
First Line	:	3990 SHERIDAN ST
Second Line	:	SUITE 206
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3656
Country	:	US
Telephone Number	:	954-987-8183
Fax Number	:	957-987-4186

Provider Business Practice Location Address
First Line	:	3990 SHERIDAN ST
Second Line	:	SUITE 206
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3656
Country	:	US
Telephone Number	:	954-987-8183
Fax Number	:	957-987-4186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	12/31/2014

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