Provider Demographics
NPI:1407062391
Name:GARRIGA-DIAZ, JOSE RAUL I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAUL
Last Name:GARRIGA-DIAZ
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4014 NW COLONIAL GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-4856
Mailing Address - Country:US
Mailing Address - Phone:386-754-0156
Mailing Address - Fax:386-752-2242
Practice Address - Street 1:7906 E US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-6290
Practice Address - Country:US
Practice Address - Phone:386-755-3379
Practice Address - Fax:386-752-2242
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011873208D00000X
FLACN140208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice