Provider Demographics
NPI:1144410135
Name:DIAZ-MUNIZ, JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:DIAZ-MUNIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JESUS
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6312 E 101ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7007
Mailing Address - Country:US
Mailing Address - Phone:918-456-2549
Mailing Address - Fax:918-893-6202
Practice Address - Street 1:816 RUDOLPH WAY
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025-8312
Practice Address - Country:US
Practice Address - Phone:812-537-1668
Practice Address - Fax:812-537-1625
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31630208D00000X
IN01067757A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice