MEDICARE: DR. MANUEL LOPEZ 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	207P00000X	Emergency Medicine Physician	ME0083364	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
2	P00414260	OTHER		RR MCR
3	28010	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255311338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL LOPEZ DIAZ MD

Provider Business Mailing Address
First Line	:	3103 SW 156TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4920
Country	:	US
Telephone Number	:	305-226-7431
Fax Number	:	888-959-7905

Provider Business Practice Location Address
First Line	:	9333 SW 152ND ST
Second Line	:	EMERGENCY DEPARTMENT
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-1778
Country	:	US
Telephone Number	:	305-256-5001
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	05/01/2017

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