Provider Demographics
NPI:1215178975
Name:DIAZ, JOHN ANSON (LRCP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANSON
Last Name:DIAZ
Suffix:
Gender:M
Credentials:LRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 MCPHERSON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8827
Mailing Address - Country:US
Mailing Address - Phone:501-920-1754
Mailing Address - Fax:
Practice Address - Street 1:8625 W MARKHAM ST
Practice Address - Street 2:STE C
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2312
Practice Address - Country:US
Practice Address - Phone:501-219-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29172278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Rehabilitation