Individual
STEFANIE M DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1133 MEDICAL DR, TYLER, TX 75701-2130
(903) 595-5486
(903) 595-5128
Mailing address
1133 MEDICAL DR, TYLER, TX 75701-2130
(903) 595-5486
(903) 595-5128
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
K8739
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040253901
—
TX
05
—
200214910 A
—
OK
01
—
390006572
RAILROAD MEDICARE
—
Enumeration date
01/09/2007
Last updated
04/20/2023
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