Provider Demographics
NPI:1487663373
Name:DIAZ, JORGE ORLANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ORLANDO
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5224 WEST S R 46 #376
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9230
Mailing Address - Country:US
Mailing Address - Phone:407-444-4848
Mailing Address - Fax:407-444-4870
Practice Address - Street 1:1331 S INTERNATIONAL PKWY STE 1261
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1405
Practice Address - Country:US
Practice Address - Phone:407-444-4848
Practice Address - Fax:407-444-4870
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME85198207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00387983OtherRAILROAD MEDICARE
FL276817800Medicaid
FL203337822OtherTAX ID
FL56503OtherBCBS
FL56503OtherBCBS
FL276817800Medicaid