Individual
PAUL DIAZ-GRANADOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8202
(904) 202-2000
(904) 346-0864
Mailing address
PO BOX 11349, DAYTONA BEACH, FL 32120-1349
(386) 274-7800
(386) 274-7801
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME119920
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012206500
—
FL
01
—
14X6E
BCBS
FL
Enumeration date
03/28/2011
Last updated
11/19/2014
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