Provider Demographics
NPI:1023456043
Name:DIAZ URRUTIA, LIEGE ISABEL (MD)
Entity type:Individual
Prefix:
First Name:LIEGE
Middle Name:ISABEL
Last Name:DIAZ URRUTIA
Suffix:
Gender:F
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:
Practice Address - Street 1:3001 CORAL HILLS DR STE 250
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4175
Practice Address - Country:US
Practice Address - Phone:954-721-5400
Practice Address - Fax:877-840-6994
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18682390200000X
FLME161493207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program