Defazio, Michael Vincent
Defazio, Michael Vincent is an individual health care provider with primary practice located at 14546 Old Saint Augustine Rd Ste 407 , Jacksonville FL 32258-5473. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, which is considered as his primary health care specialty. Defazio, Michael Vincent can be contacted via phone (904) 262-3372.Contact Information
Primary practice address
14546 Old Saint Augustine Rd Ste 407
Jacksonville FL 32258-5473
Phone: (904) 262-3372
Fax: (904) 262-3306
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery | 2086S0122X | R6770 | Texas |
Profile Details
| NPI number | 1821354325 |
|---|---|
| LBN Legal business name | Defazio, Michael Vincent |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 9th, 2012 |
| Last updated | Aug 1st, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821354325 | NPPES |
| Texas | Other | 8JM813 | BCBS |
| Texas | MEDICAID | 387059402 | BCBS |
| Texas | MEDICAID | 387059401 | BCBS |
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