Individual
MR. LARRY JOSE DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2122 HEALTH DR SW, WYOMING, MI 49519-9698
(616) 252-5950
(616) 252-5956
Mailing address
5900 BYRON CENTER AVE SW, MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-3243
(616) 252-0260
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
203831
MA
207RC0000X
Cardiovascular Disease Physician
Primary
4301097454
MI
207RC0000X
Cardiovascular Disease Physician
ME93966
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301097454
STATE LICENSE
MI
Enumeration date
07/29/2005
Last updated
12/08/2017
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