Provider Demographics
NPI:1568568723
Name:MORALES-DIAZ, MIRZA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRZA
Middle Name:E
Last Name:MORALES-DIAZ
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3061
Mailing Address - Street 2:PARK SLOPE FAMILY HEALTH CENTER
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-3061
Mailing Address - Country:US
Mailing Address - Phone:865-985-7012
Mailing Address - Fax:865-291-3224
Practice Address - Street 1:412 DEVONIA ST
Practice Address - Street 2:ROANE MEDICAL CENTER
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2009
Practice Address - Country:US
Practice Address - Phone:865-985-7234
Practice Address - Fax:865-291-3224
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-06-17
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Provider Licenses
StateLicense IDTaxonomies
TN48587207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02253538Medicaid
NY63V721Medicare ID - Type Unspecified
NY02253538Medicaid