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1821354325
MICHAEL VINCENT DEFAZIO
JACKSONVILLE, FL
NPI
1821354325
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2086S0122X Surgery, Plastic and Reconstructive Surgery
(Licence: TX R6770)
Enumeration Date
2012-04-09
Last Update Date
2019-08-01
Business Address
MICHAEL VINCENT DEFAZIO MD
14546 OLD SAINT AUGUSTINE RD STE 407
JACKSONVILLE, FL 32258-5473
Phone number: 904-262-3372
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Mailing Address
MICHAEL VINCENT DEFAZIO MD
11945 SAN JOSE BLVD STE 300
JACKSONVILLE, FL 32223-1627
Phone number: 904-396-1725
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