Provider Demographics
NPI:1679735625
Name:DIAMOND, MICHAEL J (M D)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5004 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2521
Mailing Address - Country:US
Mailing Address - Phone:214-536-6416
Mailing Address - Fax:
Practice Address - Street 1:704 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834-3836
Practice Address - Country:US
Practice Address - Phone:830-876-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2012-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4565207Q00000X
ARE-6832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine