Provider Demographics
NPI:1073824645
Name:ZERVOGIANNIS, PANAGIOTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PANAGIOTIS
Middle Name:
Last Name:ZERVOGIANNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PETE
Other - Middle Name:
Other - Last Name:ZERVOGIANNIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4710 N HABANA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7161
Mailing Address - Country:US
Mailing Address - Phone:813-873-1016
Mailing Address - Fax:813-874-2813
Practice Address - Street 1:4710 N HABANA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7161
Practice Address - Country:US
Practice Address - Phone:813-873-1016
Practice Address - Fax:813-874-2813
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125318207R00000X
FLME116974207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME116974OtherLICENSE NO
FL015142400Medicaid
FL015142400Medicaid