Provider Demographics
NPI:1154489474
Name:ELADIO DIEGUEZ MD PA
Entity Type:Organization
Organization Name:ELADIO DIEGUEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELADIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-873-2300
Mailing Address - Street 1:PO BOX 770967
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34477-0967
Mailing Address - Country:US
Mailing Address - Phone:352-873-2300
Mailing Address - Fax:
Practice Address - Street 1:5345 SW COLLEGE RD # 401
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5717
Practice Address - Country:US
Practice Address - Phone:352-873-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1367Medicare ID - Type Unspecified