Provider Demographics
NPI:1417144353
Name:DIAZ, JASON A (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7509
Mailing Address - Fax:314-362-7522
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 11A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7509
Practice Address - Fax:314-747-9744
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2014-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2009016631207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology