MEDICARE: JOHN RUFO 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780489765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN RUFO DIAZ MD

Provider Business Mailing Address
First Line	:	166 WICKLIFFE DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-1334
Country	:	US
Telephone Number	:	239-877-8522
Fax Number	:

Provider Business Practice Location Address
First Line	:	5470 BRYSON CT
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-6000
Country	:	US
Telephone Number	:	239-451-9747
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MD
Name	:	DR. JOHN R DIAZ
Credential	:	MD
Telephone Number	:	239-877-8522

Provider Enumeration Date	:	02/14/2025
Last Update Date	:	02/14/2025

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