Provider Demographics
NPI:1629568340
Name:DIAZ, DERRICK HENRY (MD)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:HENRY
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 1:1360 S DIXIE HWY STE 355
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2656
Mailing Address - Country:US
Mailing Address - Phone:954-706-6800
Mailing Address - Fax:954-827-5706
Practice Address - Street 1:1360 S DIXIE HWY STE 355
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2656
Practice Address - Country:US
Practice Address - Phone:954-706-6800
Practice Address - Fax:954-827-5706
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine