Provider Demographics
NPI:1275596850
Name:DIAZ-PAGAN, JOSE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:DIAZ-PAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 RIM RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2741
Mailing Address - Country:US
Mailing Address - Phone:915-593-6700
Mailing Address - Fax:915-593-6703
Practice Address - Street 1:10501 VISTA DEL SOL DR
Practice Address - Street 2:SUITE 220
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7940
Practice Address - Country:US
Practice Address - Phone:915-593-6700
Practice Address - Fax:915-593-6703
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6356207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG11614Medicare UPIN
TX8A7905Medicare ID - Type Unspecified
TX00354VMedicare ID - Type Unspecified