Provider Demographics
NPI:1720104276
Name:JOSE LUIS DIAZ, M.D. P.A.
Entity Type:Organization
Organization Name:JOSE LUIS DIAZ, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-593-6700
Mailing Address - Street 1:PO BOX 26734
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79926-6734
Mailing Address - Country:US
Mailing Address - Phone:915-593-6700
Mailing Address - Fax:915-593-6703
Practice Address - Street 1:10501 VISTA DEL SOL
Practice Address - Street 2:SUITE 220
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7941
Practice Address - Country:US
Practice Address - Phone:915-593-6700
Practice Address - Fax:915-593-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0087KAOtherBCBS
TX159892201Medicaid
TX00354VMedicare ID - Type Unspecified