MEDICARE: DAVID RAY 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	2084P0015X	Psychosomatic Medicine Physician	01034550A	IN
2	2084P0800X	Psychiatry Physician	01034550A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ7541	OTHER	IN	MEDICARE RR GROUP#
3	264430910	OTHER	IN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P02556180	OTHER	IN	RAILROAD PTAN

General Provider Information

NPI Number	:	1932101391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID RAY DIAZ MD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 W 16TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2207
Country	:	US
Telephone Number	:	317-963-7300
Fax Number	:	317-963-7325

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/24/2024

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Directions to “ DAVID RAY DIAZ MD” Practice Location

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