Provider Demographics
NPI:1033106380
Name:DIAZ, DAVID ALAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
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 1:15930 S GREAT OAKS DR
Mailing Address - Street 2:A-200
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5526
Mailing Address - Country:US
Mailing Address - Phone:512-246-3338
Mailing Address - Fax:512-246-3368
Practice Address - Street 1:15930 S GREAT OAKS DR
Practice Address - Street 2:A-200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5526
Practice Address - Country:US
Practice Address - Phone:512-246-3338
Practice Address - Fax:512-246-3368
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ1080OtherSTATE MEDICAL LICENSE
TXJ1080OtherSTATE MEDICAL LICENSE
8B8579Medicare ID - Type Unspecified