Provider Demographics
NPI:1013221282
Name:MACEDO DIAS, ANDRE DCP (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:DCP
Last Name:MACEDO DIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDRE
Other - Middle Name:
Other - Last Name:MACEDO DIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-720-0599
Mailing Address - Fax:904-376-4036
Practice Address - Street 1:11236 BAPTIST HEALTH DR STE 310
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218
Practice Address - Country:US
Practice Address - Phone:904-224-9309
Practice Address - Fax:904-764-0086
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454365207R00000X
CT052065207R00000X
FLME136812207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology