Provider Demographics
NPI:1639220379
Name:DIAZ, GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
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 1:316 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2943
Mailing Address - Country:US
Mailing Address - Phone:956-664-0002
Mailing Address - Fax:956-664-2924
Practice Address - Street 1:316 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2943
Practice Address - Country:US
Practice Address - Phone:956-664-0002
Practice Address - Fax:956-664-2924
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3711174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CJ208OtherBCBS
TXP00761187OtherRR MEDICARE
TX089944503Medicaid
TX8CJ208OtherBCBS