Provider Demographics
NPI:1376530188
Name:DIAZ, CHRISTOPHER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:DIAZ
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.085504208D00000X
TXN9692207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00966738OtherRAIL ROAD
TX283196801Medicaid
TX75-2616977-001OtherTRICARE
TX8DQ153OtherBCBS
TX283196802Medicaid
TX75-2616977-028OtherTRICARE
TX8CV291OtherBCBS
TX283196803Medicaid
TX75-0818167-044OtherTRICARE
TX75-2616977-002OtherTRICARE
TX8EZ069OtherBCBS
TX283196809Medicaid
TX75-0818167-048OtherTRICARE
TXP01464105OtherRAIL ROAD MEDICARE
TX750818167022OtherTRICARE
TX8CV290OtherBCBS
TX8CV291OtherBCBS
TX8DQ153OtherBCBS
TX8CV290OtherBCBS
TX283196802Medicaid
TX75-2616977-001OtherTRICARE
TX270702YNSXMedicare Oscar/Certification