Individual
DAVID RAY DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
355 W 16TH ST, INDIANAPOLIS, IN 46202-2207
(317) 963-7300
(317) 963-7325
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
01034550A
IN
2084P0800X
Psychiatry Physician
Primary
01034550A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100126480
—
IN
01
—
264430910
MEDICARE PTAN
IN
01
—
CJ7541
MEDICARE RR GROUP#
IN
01
—
P02556180
RAILROAD PTAN
IN
Enumeration date
08/15/2005
Last updated
04/24/2024
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