MEDICARE: DR. GERSON PAUL DIAZ D.C.

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	111N00000X	Chiropractor	CH0006765	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	:	1487730891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERSON PAUL DIAZ D.C.

Provider Business Mailing Address
First Line	:	10700 CARIBBEAN BLVD
Second Line	:	SUITE 206
City	:	MIAMI
State	:	FL
Zip	:	33189-1232
Country	:	US
Telephone Number	:	305-255-3005
Fax Number	:	305-255-7689

Provider Business Practice Location Address
First Line	:	10700 CARIBBEAN BLVD
Second Line	:	SUITE 206
City	:	MIAMI
State	:	FL
Zip	:	33189-1230
Country	:	US
Telephone Number	:	305-255-3005
Fax Number	:	305-255-7689

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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