Provider Demographics
NPI:1679521173
Name:DIAZ, VICTOR A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:A
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CURIE DR
Mailing Address - Street 2:STE 1500
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2905
Mailing Address - Country:US
Mailing Address - Phone:915-543-9600
Mailing Address - Fax:915-543-9700
Practice Address - Street 1:1700 CURIE DR
Practice Address - Street 2:STE 1500
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2905
Practice Address - Country:US
Practice Address - Phone:915-543-9600
Practice Address - Fax:915-543-9700
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5519208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0087Z175OtherBCBS-TX PROVIDER NUMBER
87Z175Medicare ID - Type Unspecified
TX0087Z175OtherBCBS-TX PROVIDER NUMBER