Provider Demographics
NPI:1285793257
Name:SANCHEZ, WILFREDO (MD)
Entity type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653-1 W 8TH ST # L13
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-3050
Mailing Address - Fax:904-244-3028
Practice Address - Street 1:653-1 W 8TH ST # L13
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3050
Practice Address - Fax:904-244-3028
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 99627207R00000X
FLME99627207R00000X, 207RI0200X
FLTRN5696207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2791943-00Medicaid
GA647550681AMedicaid
FLAG351XMedicare PIN
GA647550681AMedicaid
FLAG351ZMedicare PIN