Individual
DR. JORGE ORLANDO DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1331 S INTERNATIONAL PKWY STE 1261, LAKE MARY, FL 32746-1405
(407) 444-4848
(407) 444-4870
Mailing address
5224 WEST S R 46 #376, SANFORD, FL 32771-9230
(407) 444-4848
(407) 444-4870
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
ME85198
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203337822
TAX ID
FL
05
—
276817800
—
FL
01
—
56503
BCBS
FL
01
—
P00387983
RAILROAD MEDICARE
FL
Enumeration date
08/07/2006
Last updated
09/08/2021
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