Provider Demographics
NPI:1962406751
Name:DIAZ, TONY (DO)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W 20TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1897
Mailing Address - Country:US
Mailing Address - Phone:305-822-0401
Mailing Address - Fax:305-824-1748
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-822-0401
Practice Address - Fax:305-824-1748
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-12-06
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLOS6699207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47987OtherBCBS
FL264540800Medicaid
FL7708523OtherAETNA PPO
FL3395788OtherAETNA HMO
FL591272217OtherHUMANA
FL288361OtherAVMED
FL046716OtherNEIGHBORHOOD HEALTH
FL47987OtherBCBS
FLH66029Medicare UPIN