Healthcare Provider Details

I. General information

NPI: 1134574239
Provider Name (Legal Business Name): EBER AZEVEDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 OCOEE APOPKA RD
APOPKA FL
32703-9210
US

IV. Provider business mailing address

8952 LAKE KATHRYN DR
PONTE VEDRA BEACH FL
32082-2955
US

V. Phone/Fax

Practice location:
  • Phone: 407-652-7026
  • Fax: 407-652-7027
Mailing address:
  • Phone: 630-957-7917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number140199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: