Provider Demographics
NPI:1396754172
Name:JORGE O DIAZ MD PA
Entity type:Organization
Organization Name:JORGE O DIAZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-444-4848
Mailing Address - Street 1:5224 W STATE ROAD 46
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9230
Mailing Address - Country:US
Mailing Address - Phone:407-444-4848
Mailing Address - Fax:407-444-4870
Practice Address - Street 1:1331 S INTERNATIONAL PKWY STE 1261
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1405
Practice Address - Country:US
Practice Address - Phone:407-444-4848
Practice Address - Fax:407-444-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDF7204OtherRAILROAD MEDICARE
FL=========OtherTAX ID
FLQ0565Medicare PIN