Provider Demographics
NPI:1518909167
Name:VAZQUEZ, ALEXIS AUGUSTINE (DO)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:AUGUSTINE
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 13TH AVE S STE 245
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3238
Mailing Address - Country:US
Mailing Address - Phone:904-396-0300
Mailing Address - Fax:904-396-3039
Practice Address - Street 1:1361 13TH AVE S STE 245
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250
Practice Address - Country:US
Practice Address - Phone:904-493-7174
Practice Address - Fax:904-694-0696
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9778207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7983TOtherMEDICARE - INDIVIDUAL
FLOS9778OtherMEDICAL LICENSE
FL0098365-00OtherFL MEDICAID - GROUP
P01189293OtherRAILROAD MEDICARE
FL004E6OtherFLORIDA BLUE/BCBS - GROUP
FLDT8174OtherRR MCR - GROUP
FL302411OtherAVMED
FL2757133-00Medicaid
FL53029OtherFLORIDA BLUE/BCBS - INDIVIDUAL
FLGR172AOtherMEDICARE - GROUP