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Individual

GUSTAVO ADOLFO DIAZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
411 N SECTION ST STE 5, FAIRHOPE, AL 36532-2650
(251) 517-5050
(251) 517-5049
Mailing address
17026 CARLTON WAY RD, HUNTERSVILLE, NC 28078
(251) 753-2209

Taxonomy

Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
02055
NC
207YS0123X
Facial Plastic Surgery Physician
25353
AL
207YS0123X
Facial Plastic Surgery Physician
ME103280
FL

Other

Enumeration date
11/29/2006
Last updated
08/01/2019
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