Provider Demographics
NPI:1518164862
Name:DIAZ, JESUS RAFAEL (M D)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:RAFAEL
Last Name:DIAZ
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Gender:M
Credentials:M D
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Mailing Address - Street 1:440 RAYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1613
Mailing Address - Country:US
Mailing Address - Phone:915-545-6845
Mailing Address - Fax:915-581-8057
Practice Address - Street 1:4815 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2705
Practice Address - Country:US
Practice Address - Phone:915-545-8823
Practice Address - Fax:915-545-9799
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2019-04-30
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Provider Licenses
StateLicense IDTaxonomies
TXP53552085R0202X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology