1952582710 NPI number — DR. ANTONIO MANUEL DIAZ JR. M.D.

Table of content: DR. ANTONIO MANUEL DIAZ JR. M.D. (NPI 1952582710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952582710 NPI number — DR. ANTONIO MANUEL DIAZ JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
ANTONIO
Provider Middle Name:
MANUEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIAZ
Provider Other First Name:
ANTONIO
Provider Other Middle Name:
MANUEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
M.D, P.A.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1952582710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 4119
Provider Second Line Business Mailing Address:
864 CENTRAL BLVD. SUITE 100
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-541-5231
Provider Business Mailing Address Fax Number:
956-541-3230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
864 CENTRAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-541-5231
Provider Business Practice Location Address Fax Number:
956-541-3230
Provider Enumeration Date:
11/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  E5508 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 116040001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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