Provider Demographics
NPI:1679821102
Name:DIAZ, MIGUEL ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101425 OVERSEAS HWY # 190
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-4505
Mailing Address - Country:US
Mailing Address - Phone:305-852-9300
Mailing Address - Fax:305-853-1260
Practice Address - Street 1:90130 OLD HWY
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2368
Practice Address - Country:US
Practice Address - Phone:305-852-9300
Practice Address - Fax:877-485-1242
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALL.3647R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine