Provider Demographics
NPI:1205290194
Name:BOYAPATI, LAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:BOYAPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 A C SKINNER PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:80 PINNACLES DR STE 700
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2915
Practice Address - Country:US
Practice Address - Phone:386-387-8500
Practice Address - Fax:386-387-8511
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME159111207RH0003X
FLME15911207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRD498OtherMEDICARE
FL118995000Medicaid
FLPWXEWOtherFL BLUE
FLRD506OtherMEDICARE