Provider Demographics
NPI:1417948241
Name:DIAZ, JOSEPH DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2414 BABCOCK RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4870
Mailing Address - Country:US
Mailing Address - Phone:210-616-0882
Mailing Address - Fax:210-692-7833
Practice Address - Street 1:2414 BABCOCK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4870
Practice Address - Country:US
Practice Address - Phone:210-616-0882
Practice Address - Fax:210-692-7833
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4980207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15224Medicare UPIN
TX81T251Medicare PIN