Individual
JOSE DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9981 S HEALTHPARK DR FL DR4, FORT MYERS, FL 33908-3618
(239) 343-5651
(239) 343-5652
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-5651
(239) 343-5652
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ME0085425
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265196300
—
FL
Enumeration date
06/14/2006
Last updated
04/04/2022
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