person
Michael Vincent Defazio, MD
Plastic and Reconstructive Surgery Physician in Jacksonville, Florida
NPI 1821354325

Michael Vincent Defazio is a Plastic and Reconstructive Surgery Physician based in Jacksonville, FL and is specialized in Plastic and Reconstructive Surgery. Michael Vincent Defazio practices in Jacksonville, FL and has the professional credentials of MD. The NPI Number for Michael Vincent Defazio is 1821354325 and holds a License No. R6770 (Florida).

The current practice location address for Michael Vincent Defazio is 14546 Old Saint Augustine Rd Ste 407, Jacksonville, FL and can be reached out via phone at 904-262-3372 and via fax at 904-262-3306. You can also correspond with Michael Vincent Defazio through the mailing address at 11945 SAN JOSE BLVD STE 300, JACKSONVILLE, FL - 32223-1627 (mailing address contact number: 904-396-1725).

Location: 14546 Old Saint Augustine Rd Ste 407, Jacksonville, FL, 32223-1627
person
Provider Profile Details
NPI Number
1821354325
Provider Name
Michael Vincent Defazio
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
14546 Old Saint Augustine Rd Ste 407, Jacksonville, FL, 32223-1627
Phone Number
904-262-3372
Fax Number
904-262-3306
Provider Enumeration Date
04/09/2012
Last Update Date
03/09/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
8JM813 01 TX BCBS
387059402 05 TX
387059401 05 TX
institution
Provider Business Practice Location Address Details
Address
14546 Old Saint Augustine Rd Ste 407
City
State
Zip
32258-5473
Phone Number
904-262-3372
Fax Number
904-262-3306
person
Provider Business Mailing Address Details
Address
14546 Old Saint Augustine Rd Ste 407
City
State
Zip
32258-5473
Phone Number
904-262-3372
Fax Number
904-262-3306
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Surgery
Speciality
Plastic and Reconstructive Surgery
Taxonomy
License No.
R6770 (Texas)
Definition
A surgeon who specializes in plastic and reconstructive surgery.
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