Provider Demographics
NPI:1831272061
Name:DIAZ, JUAN D (DO)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:D
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:685 PALM SPRINGS DRIVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32703
Mailing Address - Country:US
Mailing Address - Phone:407-830-5577
Mailing Address - Fax:407-830-4164
Practice Address - Street 1:685 PALM SPRINGS DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7853
Practice Address - Country:US
Practice Address - Phone:407-830-5577
Practice Address - Fax:407-830-4164
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9429207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280416600Medicaid