Provider Demographics
NPI:1457403800
Name:SANCHEZ, EDUARDO AUGUSTO (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:AUGUSTO
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 1:1667 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-3346
Mailing Address - Country:US
Mailing Address - Phone:904-399-1818
Mailing Address - Fax:904-399-3500
Practice Address - Street 1:1667 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3346
Practice Address - Country:US
Practice Address - Phone:904-399-1818
Practice Address - Fax:904-399-3550
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME248972084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15313OtherBCBS FL
FL2779145-00Medicaid
FL2779145-00Medicaid
FLP00715978Medicare PIN
FLAD865ZMedicare PIN