Emanuel Diaz, MD
Individual provider Active NPI Family Medicine Physician · Patrick Afb, FL
NPI 1457538217 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1457538217
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036-122688 (IL)
- Practice address
- 1381 S Patrick Dr
Patrick Afb, FL 32925-3606 - Phone
- (321) 494-8216
- NPI assigned
- Jan 23, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150303000862 | FL | Order and Referring Only - Family Practice |
6608192034 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-122688 | IL | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036-122688 | IL | Yes |
Addresses
Primary practice location
1381 S Patrick Dr
Patrick Afb, FL 32925-3606
Mailing address
316 Barrymore Dr
Rockledge, FL 32955-4760
Phone (630) 618-9559
Other providers in Patrick Afb, FL
- Candace Nason Croft
- Austin S Davis
- Efrain A Delvalle
- Daniel Stephen Demick
- Minal S Desai
- Glenn Donnelly
- Paul Drylewski
- Randy W Dutton
- Jose F Eduardo
- Jade Esmailzadeh
All providers in Patrick Afb, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.