MEDICARE: FERNANDO N DIAZ, MD. PA

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

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	:	1891068300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNANDO N DIAZ, MD. PA

Provider Business Mailing Address
First Line	:	3990 SHERIDAN STREET. SUITE 206
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3656
Country	:	US
Telephone Number	:	954-987-8183
Fax Number	:	954-894-9937

Provider Business Practice Location Address
First Line	:	3990 SHERIDAN ST STE 206
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3656
Country	:	US
Telephone Number	:	954-987-8183
Fax Number	:	954-894-9937

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FERNANDO N DIAZ
Credential	:	M.D.
Telephone Number	:	954-987-8183

Provider Enumeration Date	:	02/14/2012
Last Update Date	:	02/14/2012

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