Provider Demographics
NPI:1740953926
Name:JORGE O DIAZ MD PA
Entity type:Organization
Organization Name:JORGE O DIAZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:O
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-444-4848
Mailing Address - Street 1:5224 SR 46 # 376
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9230
Mailing Address - Country:US
Mailing Address - Phone:407-444-4848
Mailing Address - Fax:407-444-4870
Practice Address - Street 1:601 E DIXIE AVE STE 101
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7307
Practice Address - Country:US
Practice Address - Phone:407-444-4848
Practice Address - Fax:407-444-4870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JORGE O DIAZ, MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty