MICHAEL VINCENT DEFAZIO


Address: 14546 Old Saint Augustine Rd Ste 407, Jacksonville, FL 32258-5473
Phone: 9042623372

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2086S0122X Surgery
Specialization: Plastic and Reconstructive Surgery
R6770 TX Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
TX 387059401 05
TX 387059402 05
TX BCBS 8JM813 01

Provider Secondary Practice Location

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

Other Providers MICHAEL DEFAZIO

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

Office Location

Street Address 14546 OLD SAINT AUGUSTINE RD STE 407
City JACKSONVILLE
State FL
Zip Code 32258-5473

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 2086S0122X
Grouping Allopathic & Osteopathic Physicians
Classification Surgery
Specialization Plastic and Reconstructive Surgery

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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

Competitor

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City JACKSONVILLE
Zip Code 32258

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Dataset Information

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.

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