Provider Demographics
NPI:1508284498
Name:DIAZ, MEGGIE ELISE (MD)
Entity type:Individual
Prefix:
First Name:MEGGIE
Middle Name:ELISE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGGIE
Other - Middle Name:ELISE
Other - Last Name:HIXSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:2800 CHERRY LN
Practice Address - Street 2:STE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-3921
Practice Address - Country:US
Practice Address - Phone:682-303-2800
Practice Address - Fax:682-303-2799
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXR0413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program