Provider Demographics
NPI:1174699870
Name:DIAZ, FERNANDO N (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:N
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3990 SHERIDAN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3656
Mailing Address - Country:US
Mailing Address - Phone:954-987-8183
Mailing Address - Fax:957-987-4186
Practice Address - Street 1:3990 SHERIDAN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3656
Practice Address - Country:US
Practice Address - Phone:954-987-8183
Practice Address - Fax:957-987-4186
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0036602207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039555200Medicaid
D64621Medicare UPIN
FL039555200Medicaid