1083611677 NPI number — GEORGE C DIAZ MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083611677 NPI number — GEORGE C DIAZ MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DIAZ

Provider First Name:

GEORGE

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1083611677

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/14/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2900 CORPORATE WAY

Provider Second Line Business Mailing Address:

DOOR D

Provider Business Mailing Address City Name:

MIRAMAR

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33025-3925

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

954-276-5685

Provider Business Mailing Address Fax Number:

954-985-7074

Provider First Line Business Practice Location Address:

2063 BISCAYNE BLVD FL 5

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MIAMI

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

33137

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

305-682-2900

Provider Business Practice Location Address Fax Number:

786-753-6131

Provider Enumeration Date:

06/28/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2084N0400X , with the licence number:  ME0066992 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 238332 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 26252 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 400000450000 . This is a "PREFERRED CARE PARTNERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: NNC106 . This is a "WELLCARE/STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 30573 . This is a "NHP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 4243290 . This is a "AETNA LIFE INS CO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 7911330 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 3000011 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: F91226 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 1024133 . This is a "CARE PLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 376445100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".