Provider Demographics
NPI:1134180458
Name:DIAZ, EDGARD O (MD)
Entity type:Individual
Prefix:DR
First Name:EDGARD
Middle Name:O
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11913
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1913
Mailing Address - Country:US
Mailing Address - Phone:787-999-0753
Mailing Address - Fax:787-999-0970
Practice Address - Street 1:2213 PONCE BY PASS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-840-8686
Practice Address - Fax:787-841-7228
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9169208M00000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist