Provider Demographics
NPI:1750398590
Name:DIAZ, THOMAS GUERRA (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GUERRA
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 1:1331 W GRAND PARKWAY N
Mailing Address - Street 2:SUITE 345
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2736
Mailing Address - Country:US
Mailing Address - Phone:281-398-8044
Mailing Address - Fax:281-574-3972
Practice Address - Street 1:1331 W GRAND PKWY N
Practice Address - Street 2:SUITE 345
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2710
Practice Address - Country:US
Practice Address - Phone:281-398-8044
Practice Address - Fax:281-574-3972
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U51COtherBCBS PROVIDER #
TX00U51COtherBCBS PROVIDER #
TX00U51CMedicare ID - Type UnspecifiedMCR PROVIDER #