Provider Demographics
NPI:1477658342
Name:LUZ, VINCENT S (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:S
Last Name:LUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WHETSTONE PL STE 211
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5775
Mailing Address - Country:US
Mailing Address - Phone:904-342-7648
Mailing Address - Fax:904-342-8567
Practice Address - Street 1:100 WHETSTONE PL STE 211
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5775
Practice Address - Country:US
Practice Address - Phone:904-342-7648
Practice Address - Fax:904-342-8567
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90727208000000X
OK27424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263972605Medicaid
FL263972606Medicaid
FL263972601Medicaid
FL263972604Medicaid
FL263972600Medicaid
FL270050600Medicaid
FL263972602Medicaid
FL263972603Medicaid