MEDICARE: DR. JESUS ANTONIO 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	207RP1001X	Pulmonary Disease Physician	ME86529	FL
2	207R00000X	Internal Medicine Physician	ME86529	FL
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	ME86529	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	:	1326009515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS ANTONIO DIAZ MD

Provider Business Mailing Address
First Line	:	4205 BELFORT RD STE 4015
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3623
Country	:	US
Telephone Number	:
Fax Number	:	904-450-6401

Provider Business Practice Location Address
First Line	:	4203 BELFORT RD STE 345
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1469
Country	:	US
Telephone Number	:	904-450-6461
Fax Number	:	904-450-6469

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	03/29/2018

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