MEDICARE: EDWIN A 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	208800000X	Urology Physician	E4076	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00137126	OTHER	AR	RAILROAD MEDICARE

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	:	1275508939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN A DIAZ M.D.

Provider Business Mailing Address
First Line	:	3401 SPRINGHILL DR
Second Line	:	SUITE345
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2924
Country	:	US
Telephone Number	:	501-945-2121
Fax Number	:	501-537-1875

Provider Business Practice Location Address
First Line	:	3401 SPRINGHILL DR
Second Line	:	SUITE345
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2924
Country	:	US
Telephone Number	:	501-945-2121
Fax Number	:	501-537-1875

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	12/05/2007

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Directions to “ EDWIN A DIAZ M.D.” Practice Location

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