Provider Demographics
NPI:1215908371
Name:DIAZ, DENIS MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:DENIS
Middle Name:MANUEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 DAVID WALKER DR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5745
Mailing Address - Country:US
Mailing Address - Phone:352-343-3330
Mailing Address - Fax:
Practice Address - Street 1:1765 DAVID WALKER DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5745
Practice Address - Country:US
Practice Address - Phone:352-343-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235887208000000X
NC2009-00227208000000X
FLME118501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics