Provider Demographics
NPI:1376578922
Name:DIAZ, REX GALAM (DPM)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:GALAM
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 VOLVO PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1621
Mailing Address - Country:US
Mailing Address - Phone:757-252-4200
Mailing Address - Fax:757-410-9670
Practice Address - Street 1:725 VOLVO PKWY STE 210
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1621
Practice Address - Country:US
Practice Address - Phone:757-252-4200
Practice Address - Fax:757-410-9670
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01033000814213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010135729Medicaid
VA5411080001OtherMEDICARE-DME
VA010135729Medicaid
VAU83851Medicare UPIN
VA00W236R01Medicare ID - Type Unspecified