Provider Demographics
NPI:1841751849
Name:DIAZ, ALEXANDER NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:NICHOLAS
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 1:3218 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-3055
Mailing Address - Country:US
Mailing Address - Phone:954-218-1166
Mailing Address - Fax:
Practice Address - Street 1:500 DR MARTIN LUTHER KING JR ST N STE 304
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1470
Practice Address - Country:US
Practice Address - Phone:727-210-5253
Practice Address - Fax:727-290-4323
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-31
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3460207P00000X
390200000X
FLME167124207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty