Provider Demographics
NPI:1881631877
Name:DIEGUEZ, ELADIO J (MD)
Entity Type:Individual
Prefix:
First Name:ELADIO
Middle Name:J
Last Name:DIEGUEZ
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 1:5345 SW COLLEGE RD STE 401
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5717
Mailing Address - Country:US
Mailing Address - Phone:352-873-2300
Mailing Address - Fax:352-873-8424
Practice Address - Street 1:5345 SW COLLEGE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5717
Practice Address - Country:US
Practice Address - Phone:352-873-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME056064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593669759OtherTAX ID
FL379327300Medicaid
FL28285OtherBCBS
FL593669759OtherTAX ID
FLK1367Medicare ID - Type Unspecified