Individual
JOSE A DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2780 CLEVELAND AVE, # 702, FORT MYERS, FL 33901
(239) 343-3474
(239) 343-2968
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-1479
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
ME92159
FL
2086S0127X
Trauma Surgery Physician
Primary
ME92159
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000771800
—
FL
Enumeration date
11/25/2008
Last updated
08/02/2018
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