Provider Demographics
NPI:1831538016
Name:DIAZ BALZAC, ROBERTO JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:JOSE
Last Name:DIAZ BALZAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WINDERLEY PL
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7247
Mailing Address - Country:US
Mailing Address - Phone:407-875-0555
Mailing Address - Fax:
Practice Address - Street 1:7727 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8224
Practice Address - Country:US
Practice Address - Phone:407-303-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127423207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine