Provider Demographics
NPI:1992065163
Name:COUTO BARBOSA, ELIAS IVAN (MD)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:IVAN
Last Name:COUTO BARBOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:655 WEST 8TH ST.
Mailing Address - Street 2:ACC BLDG, 4TH FLOOR
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:904-383-1013
Mailing Address - Fax:904-244-2165
Practice Address - Street 1:820 PRUDENTIAL DR STE 304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8205
Practice Address - Country:US
Practice Address - Phone:904-202-3860
Practice Address - Fax:904-202-3846
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124789207R00000X, 208M00000X
FL124789207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME124789OtherFLORIDA BOARD OF MEDICINE