Provider Demographics
NPI:1003842121
Name:EL GOWENI, HEBA (MD)
Entity Type:Individual
Prefix:
First Name:HEBA
Middle Name:
Last Name:EL GOWENI
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 1:8880 NAVARRE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-3612
Mailing Address - Country:US
Mailing Address - Phone:850-939-5550
Mailing Address - Fax:850-939-5445
Practice Address - Street 1:8880 NAVARRE PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-3612
Practice Address - Country:US
Practice Address - Phone:850-939-5550
Practice Address - Fax:850-939-5445
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME857912080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29224OtherBLUE CROSS BLUE SHIELD OF FLORIDA
AL591-68677OtherBLUE CROSS BLUE SHIELD OF ALABAMA
FL266616200Medicaid
FL29224OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL266616200Medicaid