Provider Demographics
NPI:1083611677
Name:DIAZ, GEORGE C (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:C
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:2063 BISCAYNE BLVD FL 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137
Practice Address - Country:US
Practice Address - Phone:305-682-2900
Practice Address - Fax:786-753-6131
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME00669922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL238332OtherAVMED
FL26252OtherBLUE CROSS BLUE SHIELD
FL400000450000OtherPREFERRED CARE PARTNERS
FLNNC106OtherWELLCARE/STAYWELL
FL30573OtherNHP
FL4243290OtherAETNA LIFE INS CO
FL7911330OtherGHI
FL3000011OtherCIGNA
FLF91226OtherVISTA
FL1024133OtherCARE PLUS
FL376445100Medicaid
FL7911330OtherGHI
FL30573OtherNHP
FL26252XMedicare PIN