Provider Demographics
NPI:1538137518
Name:DIAZ, HECTOR JOSE (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:JOSE
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 JAMES REDMANN PRKWY
Mailing Address - Street 2:# 168
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563
Mailing Address - Country:US
Mailing Address - Phone:813-757-1290
Mailing Address - Fax:
Practice Address - Street 1:9780 N 56TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5508
Practice Address - Country:US
Practice Address - Phone:813-549-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050679207P00000X
FLME50679207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00217513OtherRR MCR
FL046149100Medicaid
FL03957OtherBCBS
FL03957EMedicare PIN
FLD60996Medicare UPIN