MEDICARE: DR. DENIS MANUEL DIAZ M.D.

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	208000000X	Pediatrics Physician	0101235887	VA
2	208000000X	Pediatrics Physician	2009-00227	NC
3	208000000X	Pediatrics Physician	ME118501	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	:	1215908371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENIS MANUEL DIAZ M.D.

Provider Business Mailing Address
First Line	:	1765 DAVID WALKER DR
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5745
Country	:	US
Telephone Number	:	352-343-3330
Fax Number	:

Provider Business Practice Location Address
First Line	:	1765 DAVID WALKER DR
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5745
Country	:	US
Telephone Number	:	352-343-3330
Fax Number	:

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	06/03/2014

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