Provider Demographics
NPI:1053308338
Name:ECHEVERRI, DIEGO (MD)
Entity Type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:
Last Name:ECHEVERRI
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 1:2951 NW 49TH AVE.
Mailing Address - Street 2:SUITE #101
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:954-739-2511
Mailing Address - Fax:954-739-9239
Practice Address - Street 1:2951 NW 49TH AVE.
Practice Address - Street 2:SUITE #101
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-739-2511
Practice Address - Fax:954-739-9239
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61527207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBCBSOther14795
FLCAREPLUSOther1000611
FL370037200Medicaid
FLAVMEDOther217042
FLAMERIGROUPOther200500
F24873Medicare UPIN
FLF24873Medicare UPIN
FLCAREPLUSOther1000611