Provider Demographics
NPI:1801827175
Name:AKRA, LOUIS ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:ANTHONY
Last Name:AKRA
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 1:1551 ATLANTIC BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3359
Mailing Address - Country:US
Mailing Address - Phone:904-379-9327
Mailing Address - Fax:904-379-3764
Practice Address - Street 1:1551 ATLANTIC BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3359
Practice Address - Country:US
Practice Address - Phone:904-379-9327
Practice Address - Fax:904-379-3764
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF94090Medicare UPIN
FL26227XMedicare ID - Type Unspecified