Provider Demographics
NPI:1336111533
Name:VALDEZ DIAZ, JONATAN DE JESUS (MD)
Entity Type:Individual
Prefix:
First Name:JONATAN
Middle Name:DE JESUS
Last Name:VALDEZ DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1900 DON WICKHAM DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1979
Mailing Address - Country:US
Mailing Address - Phone:352-536-8840
Mailing Address - Fax:352-536-8840
Practice Address - Street 1:1670 ST VINCENTS WAY
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8447
Practice Address - Country:US
Practice Address - Phone:904-308-3960
Practice Address - Fax:888-730-1925
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI47902-020207R00000X
MI4301085180207R00000X
FLME109787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFP976ZMedicare PIN