Provider Demographics
NPI:1043635816
Name:DIAZ, EDUARDO MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:MANUEL
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 1:9870 GAYLORD DR APT 1112
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2672
Mailing Address - Country:US
Mailing Address - Phone:713-248-6127
Mailing Address - Fax:
Practice Address - Street 1:9870 GAYLORD DR APT 1112
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2672
Practice Address - Country:US
Practice Address - Phone:713-248-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9781207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology