MICHAEL VINCENT DEFAZIO (NPI# 1821354325) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1821354325 |
Entity Type | Individual |
Full Name | MICHAEL VINCENT DEFAZIO |
Credential | MD |
Practice Address |
14546 Old Saint Augustine Rd Ste 407 Jacksonville FL 32258-5473 |
Mailing Address |
11945 San Jose Blvd Ste 300 Jacksonville FL 32223-1627 |
Practice Telephone | 9042623372 |
Practice Fax Number | 9042623306 |
Mailing Telephone | 9043961725 |
Mailing Fax Number | 9043964893 |
Enumeration Date | 2012-04-09 |
Last Update Date | 2019-08-01 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
R6770 | TX | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
TX | 387059401 | 05 | |
TX | 387059402 | 05 | |
TX | BCBS | 8JM813 | 01 |
Address | Telephone Number | Fax Number |
---|---|---|
1400 Pressler St Unit 1488, Houston, TX 77030 | 7137941247 | 7137945492 |
3800 Reservoir Rd Nw, Dept of Plastic Surgery, Washington, DC 200072113 | 2024441233 | 2024447422 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609367465 | Michael J Defazio | Driver | 6755 Shelter Ln, Las Vegas, NV 89103-4369 | 2018-05-28 |
1497189476 | Michael Carey Defazio | Student in an Organized Health Care Education/Training Program | 3001 Green Bay Rd, Fisher Dental Clinic, North Chicago, IL 60064-3048 | 2013-08-27 |
1154407419 | Michael A Defazio | Counselor | 3734 7th Ave, Ste 24, Kenosha, WI 53140 | 2006-10-30 |
Street Address |
14546 OLD SAINT AUGUSTINE RD STE 407 |
City | JACKSONVILLE |
State | FL |
Zip Code | 32258-5473 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1578819793 | Lauren S Lynch | Physician Assistant | 14546 Old Saint Augustine Rd Ste 407, Jacksonville, FL 32258-5473 | 2012-07-25 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437794237 | Nicoleta Descalzo | Behavior Technician | 12724 Grand Bay Parkway West, Suite 410, Jacksonville, FL 32258 | 2019-11-15 |
1992275572 | William Lundgren | Nurse Anesthetist, Certified Registered | 3625 University Blvd South, Jacksonville, FL 32258 | 2018-11-27 |
1104301159 | Emergency Physicians Inc | Emergency Medicine | 14534 Old St Augustine Rd, Suite 3110, Jacksonville, FL 32258 | 2018-09-26 |
1679092886 | Palm Life Medical Associates Pa | Assisted Living Facility | 12494 Acosta Oaks Drive, Jacksonville, FL 32258 | 2017-09-19 |
1679013932 | Optometry Vision Care Pllc | Optometrist | 14866 Old St. Augustine Rd Unit 110, Jacksonville, FL 32258 | 2017-03-06 |
1467991950 | North Florida Vision Group Inc | Optometrist | 14866 Old St. Augustine Rd., Suite 110, Jacksonville, FL 32258 | 2017-02-16 |
1124576566 | Revolution Chiropractic LLC | Chiropractor | 14866 Old St Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-14 |
1396291936 | Robyn Reaves | Nurse Practitioner | 12361 Richards Glen Ct, Jacksonville, FL 32258 | 2016-09-01 |
1326595927 | Lauren Cost | Chiropractor | 14866 Old St. Augustine Road, Suite 113, Jacksonville, FL 32258 | 2016-09-01 |
1487991170 | Mark Steven Colosimo | Pharmacist | 13820 Old St Augustine Road, Jacksonville, FL 32258 | 2013-01-15 |
Find all providers in zip 32258 |
Taxonomy Code | 2086S0122X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Plastic and Reconstructive Surgery |
A surgeon who specializes in plastic and reconstructive surgery. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1003876251 | Timothy Edward Fee | Surgery | 4147 Southpoint Dr E, Jacksonville, FL 32216-0996 | 2006-03-23 |
1639164692 | David N Csikai | Surgery | 3616 Cardinal Point Dr, Jacksonville, FL 32257-5581 | 2005-09-15 |
1548586894 | Lewis J. Obi, M.d., P.a. | Surgery | 3599 University Blvd S, Suite 604, Jacksonville, FL 32216-4252 | 2010-04-12 |
1932302387 | Ankit R Desai | Surgery | 14540 Old Saint Augustine Rd, Suite # 2391, Jacksonville, FL 32258-7418 | 2007-06-05 |
1649265463 | Vaishali B Doolabh | Surgery | 6269 Beach Blvd, Suite 1, Jacksonville, FL 32216-2705 | 2005-09-19 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568025419 | Reinventme, LLC | Surgery | 13696 N Us Highway 441 Ste 100, Lady Lake, FL 32159-6815 | 2019-04-17 |
1750854378 | David Gerth Md Pa | Surgery | 4308 Alton Rd Ste 940, Miami Beach, FL 33140-4560 | 2019-01-07 |
1588165773 | Deepak Naidu Md, Pa | Surgery | 201 E Kennedy Blvd Ste 410, Tampa, FL 33602-3641 | 2018-02-23 |
1194225599 | Joseph Charles Gallagher Jr. | Surgery | 9201 Midnight Pass Rd, Sarasota, FL 34242-2921 | 2018-02-13 |
1043729569 | Renee Gasgarth, M.d. P.a. | Surgery | 7300 Sw 62nd Pl Ste 200, South Miami, FL 33143-4800 | 2017-09-27 |
1184150625 | Pamela Loftus | Surgery | 4454 Woodfield Blvd, Boca Raton, FL 33434-5310 | 2017-05-03 |
1356898324 | Waters Edge Dermatology Global LLC | Surgery | 2601 S Kanner Highway, Stuart, FL 34994 | 2016-09-07 |
1629482096 | Jill Swindell | Surgery | 1921 Waldemere St Ste 801, Sarasota, FL 34239-2913 | 2014-06-13 |
1205274784 | Melanie L Aya-ay Md Plastic Surgery Pl | Surgery | 17523 N Dale Mabry Hwy, Lutz, FL 33548-4521 | 2013-06-06 |
1790123487 | Jason Crespo | Surgery | 1250 Pine Ridge Rd Ste 101c, Naples, FL 34108-8913 | 2013-06-05 |
Find all providers with the same taxonomy |
City | JACKSONVILLE |
Zip Code | 32258 |
Please comment or provide details below to improve the information on MICHAEL VINCENT DEFAZIO.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.