Provider Demographics
NPI:1942578372
Name:DIAZ, ELIER (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIER
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 1:41022 GALVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5918
Mailing Address - Country:US
Mailing Address - Phone:225-622-1425
Mailing Address - Fax:225-622-0223
Practice Address - Street 1:41022 GALVEZ AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-5918
Practice Address - Country:US
Practice Address - Phone:225-622-1425
Practice Address - Fax:225-622-0223
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.011792208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA55976Medicaid