Individual
JOSE L DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1038 W NORTH BLVD STE 102, LEESBURG, FL 34748
(352) 315-1627
(352) 326-8744
Mailing address
1038 W NORTH BLVD STE 102, LEESBURG, FL 34748-5077
(352) 315-1627
(352) 326-8744
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME94696
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274950500
—
FL
01
—
35150
BLUE SHIELD
FL
Enumeration date
05/31/2006
Last updated
01/25/2019
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