Provider Demographics
NPI:1851586754
Name:JOSE M DIAZ M D P A
Entity Type:Organization
Organization Name:JOSE M DIAZ M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-206-2127
Mailing Address - Street 1:507 PARK GROVE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1759
Mailing Address - Country:US
Mailing Address - Phone:281-206-2127
Mailing Address - Fax:281-206-2322
Practice Address - Street 1:507 PARK GROVE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1759
Practice Address - Country:US
Practice Address - Phone:281-206-2127
Practice Address - Fax:281-206-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ09422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123680402Medicaid
TX89Y670OtherBC/BS
TX89Y670OtherBC/BS