Provider Demographics
NPI:1285744037
Name:MANUEL F DIAZ MD PA
Entity type:Organization
Organization Name:MANUEL F DIAZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRIMARY CARE PHYSICIAN INT MED
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-338-0407
Mailing Address - Street 1:1130 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4219
Mailing Address - Country:US
Mailing Address - Phone:352-333-5242
Mailing Address - Fax:352-333-6223
Practice Address - Street 1:1130 NW 64TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4219
Practice Address - Country:US
Practice Address - Phone:352-333-5242
Practice Address - Fax:352-333-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1526Medicare ID - Type Unspecified