Provider Demographics
NPI:1790846988
Name:LI, XIAOYU (M D, PH D)
Entity type:Individual
Prefix:
First Name:XIAOYU
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:M D, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 SOUTHPOINT PKWY
Mailing Address - Street 2:STE 102
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92069207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA378097680AMedicaid
FL2783797-00Medicaid
FL96423OtherBCBS
GA378097680AMedicaid
FLP00427459Medicare PIN