Provider Demographics
NPI:1487398327
Name:DIAZ, PEDRO JAVIER (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:JAVIER
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PEDRO
Other - Middle Name:JAVIER
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3310 HAGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8294
Mailing Address - Country:US
Mailing Address - Phone:956-576-8808
Mailing Address - Fax:
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10078754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine