Healthcare Provider Details

I. General information

NPI: 1790846988
Provider Name (Legal Business Name): XIAOYU LI M. D, PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY STE 102
JACKSONVILLE FL
32216-6285
US

IV. Provider business mailing address

6817 SOUTHPOINT PKWY STE 102
JACKSONVILLE FL
32216-6285
US

V. Phone/Fax

Practice location:
  • Phone: 904-513-3998
  • Fax: 904-575-4919
Mailing address:
  • Phone: 904-513-3998
  • Fax: 904-575-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberME92069
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME92069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: