Individual
MARIO DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2020 CAPITOL ST NE, SALEM, OR 97303-3244
(503) 399-2424
(503) 375-7429
Mailing address
PO BOX 8100, SALEM, OR 97303-0900
(503) 399-2424
(503) 375-7429
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
PA057229
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057229
—
OR
Enumeration date
06/04/2006
Last updated
01/18/2010
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