Provider Demographics
NPI:1093787913
Name:DIAZ, JOSE IGNACIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:IGNACIO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14960 OMICRON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-3215
Mailing Address - Country:US
Mailing Address - Phone:210-450-3846
Mailing Address - Fax:210-450-3939
Practice Address - Street 1:7979 WURZBACH RD
Practice Address - Street 2:Z 4TH FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4427
Practice Address - Country:US
Practice Address - Phone:210-450-3846
Practice Address - Fax:210-450-3939
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4033207ZP0102X, 207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J2507Medicare ID - Type Unspecified
TXF00702Medicare UPIN