Provider Demographics
NPI:1679034128
Name:NEGRON-DIAZ, JUAN ANTONIO (MC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:NEGRON-DIAZ
Suffix:
Gender:M
Credentials:MC
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:A
Other - Last Name:NEGRON DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:502 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4720
Mailing Address - Country:US
Mailing Address - Phone:352-726-1551
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXV0075207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program