MEDICARE: DR. CHONGLUN XIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME92689	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7245685	OTHER	FL	AETNA
2	16175	OTHER	FL	BCBS
3	2574641	OTHER		UNITED HEALTH CARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861457459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHONGLUN XIE MD

Provider Business Mailing Address
First Line	:	5757 BOOTH RD
Second Line	:	SUITE 200
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5980
Country	:	US
Telephone Number	:	904-636-9510
Fax Number	:	904-636-9512

Provider Business Practice Location Address
First Line	:	5757 BOOTH RD
Second Line	:	SUITE 200
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5980
Country	:	US
Telephone Number	:	904-636-9510
Fax Number	:	904-636-9512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	09/21/2018

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Directions to “ DR. CHONGLUN XIE MD” Practice Location

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