Individual
MR. MARK DIAZ III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
77 S OAKBRIDGE CT APT 105, MADISON, WI 53717-2030
(562) 659-3459
Mailing address
77 S OAKBRIDGE CT APT 105, MADISON, WI 53717-2030
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4404-23
WI
Other
Enumeration date
06/20/2018
Last updated
06/20/2018
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