Provider Demographics
NPI:1376594622
Name:SAFILLE, EDUARDO F (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:F
Last Name:SAFILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:F
Other - Last Name:SAFILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6401
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:615 PENDLETON ST STE B
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501
Practice Address - Country:US
Practice Address - Phone:912-285-9994
Practice Address - Fax:912-285-9595
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600427207RC0000X
GA080175207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00333524Medicare PIN
D63268Medicare UPIN
2052151Medicare PIN