Individual
ALEXIS AUGUSTINE VAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1361 13TH AVE S STE 245, JACKSONVILLE BEACH, FL 32250
(904) 493-7174
(904) 694-0696
Mailing address
1361 13TH AVE S STE 245, JACKSONVILLE BEACH, FL 32250-3238
(904) 396-0300
(904) 396-3039
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
OS9778
FL
207RP1001X
Pulmonary Disease Physician
Primary
OS9778
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004E6
FLORIDA BLUE/BCBS - GROUP
FL
01
—
0098365-00
FL MEDICAID - GROUP
FL
05
—
2757133-00
—
FL
01
—
302411
AVMED
FL
01
—
53029
FLORIDA BLUE/BCBS - INDIVIDUAL
FL
01
—
DT8174
RR MCR - GROUP
FL
01
—
GR172A
MEDICARE - GROUP
FL
01
—
OS9778
MEDICAL LICENSE
FL
01
—
P01189293
RAILROAD MEDICARE
—
01
—
U7983T
MEDICARE - INDIVIDUAL
FL
Enumeration date
06/11/2006
Last updated
02/24/2025
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