Provider Demographics
NPI:1962538439
Name:DIAZ, JAIME ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ALBERTO
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 1:19411 EASY OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3644
Mailing Address - Country:US
Mailing Address - Phone:888-280-8902
Mailing Address - Fax:
Practice Address - Street 1:1619 E COMMON ST STE 1201
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3464
Practice Address - Country:US
Practice Address - Phone:830-620-0330
Practice Address - Fax:830-620-5405
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24943207RG0300X
TXM9256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201628901Medicaid
TX201628906Medicaid
TX8A4707OtherBLUE CROSS
TX275676YKW1Medicare PIN
TX8L6166Medicare PIN