Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 052065 | CT |
N | 111NI0900X | Internist | 052065 | CT |
N | 207R00000X | Internist | MD454365 | PA |
N | 111NI0900X | Internist | MD454365 | PA |
Y | 207RC0000X | Internist - Cardiovascular Disease | ME136812 | FL |
NPI | 1013221282 |
---|---|
Provider Name | Dr. Andre D.c.p. Macedo Dias |
First Address | Jacksonville, FL 32203-3667 |
Second Address | Jacksonville, FL 32218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2010 |
Last Update Date | 17/07/2018 |