Provider Demographics
NPI:1417408683
Name:OCEANVIEW MEDICINE, PLLC
Entity Type:Organization
Organization Name:OCEANVIEW MEDICINE, PLLC
Other - Org Name:ADVANCED GASTROENTEROLOGY AND HEPATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAOYU
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:M D, PH D
Authorized Official - Phone:904-513-3998
Mailing Address - Street 1:6817 SOUTHPOINT PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6285
Mailing Address - Country:US
Mailing Address - Phone:904-513-3998
Mailing Address - Fax:904-575-4919
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 102
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6285
Practice Address - Country:US
Practice Address - Phone:904-513-3998
Practice Address - Fax:904-575-4919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92069207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Single Specialty