MEDICARE: ELIA C MAVROFRIDES 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	207WX0107X	Retina Specialist (Ophthalmology) Physician	ME85097	FL
2	207W00000X	Ophthalmology Physician	ME0085097	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396745105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIA C MAVROFRIDES MD

Provider Business Mailing Address
First Line	:	8786 PERIMETER PARK BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6347
Country	:	US
Telephone Number	:	904-997-9202
Fax Number	:	904-996-1446

Provider Business Practice Location Address
First Line	:	95 COLUMBIA ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-1101
Country	:	US
Telephone Number	:	407-849-9621
Fax Number	:	407-420-4056

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	04/20/2023

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