Provider Demographics
NPI:1831190412
Name:DIAZ, RICHARD F (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:F
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7401 METRO BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3086
Mailing Address - Country:US
Mailing Address - Phone:952-920-4915
Mailing Address - Fax:952-915-6091
Practice Address - Street 1:6401 FRANCE AVE S
Practice Address - Street 2:SOUTHDALE RADIATION THERAPY
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2104
Practice Address - Country:US
Practice Address - Phone:952-920-8477
Practice Address - Fax:952-920-8176
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN308032085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN108859OtherCHOICE PLUS
MN01272DIOtherBLUE CROSS/SHIELD
MN2400004OtherMEDICA PRIMARY
MN522585000Medicaid
MN104833OtherUCARE
MN25134OtherAMERICA'S PPO
MNHP13158OtherHEALTH PARTNERS
MN2413463OtherMEDICA
MN30814700Medicaid
MN963070250006OtherPREFERRED ONE