Provider Demographics
NPI:1396745105
Name:MAVROFRIDES, ELIA C (MD)
Entity type:Individual
Prefix:
First Name:ELIA
Middle Name:C
Last Name:MAVROFRIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ELIAS
Other - Middle Name:C
Other - Last Name:MAVROFRIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8786 PERIMETER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6347
Mailing Address - Country:US
Mailing Address - Phone:904-997-9202
Mailing Address - Fax:904-996-1446
Practice Address - Street 1:95 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1101
Practice Address - Country:US
Practice Address - Phone:407-849-9621
Practice Address - Fax:407-420-4056
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85097207WX0107X
FLME0085097207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264820200Medicaid
FL264820200Medicaid
H64280Medicare UPIN