MICHAEL VINCENT DEFAZIO MD NPI 1821354325

NPI Information

NPI: 1821354325
Provider Name: MICHAEL VINCENT DEFAZIO, MD
Classification: Surgery - 2086S0122X
Entity Type: Individual

Specialization: Plastic and Reconstructive Surgery

PECOS Registration: Yes

Address:
14546 OLD SAINT AUGUSTINE RD STE 407
JACKSONVILLE, FL
ZIP 32258
Phone: (904) 262-3372
Get Directions

Michael Vincent Defazio, MD is a plastic and reconstructive surgery surgery in Jacksonville, FL with 12 years of experience. The provider is a surgeon who specializes in plastic and reconstructive surgery. Michael Vincent Defazio, MD NPI is 1821354325. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF MIAMI, LM MILLER SCHOOL OF MEDICINE
Graduation Year:2012

The provider's business location address is:

14546 OLD SAINT AUGUSTINE RD STE 407
JACKSONVILLE, FL
ZIP 32258-473
Phone: (904) 262-3372
Fax: (904) 262-3306

The NPI 1821354325 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/9/2012 and was last updated on 8/1/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0122X	Surgery	Plastic and Reconstructive Surgery	R6770	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	387059401	MEDICAID	TEXAS
2	387059402	MEDICAID	TEXAS
3	8JM813	OTHER	TEXAS	BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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