Provider Demographics
NPI:1174501571
Name:TRIBUZIO, EDWARD DOMINICK (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DOMINICK
Last Name:TRIBUZIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:1132 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-2920
Practice Address - Country:US
Practice Address - Phone:904-432-3061
Practice Address - Fax:904-432-3062
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNG830OtherMEDICARE
FL067854600Medicaid
FL45033OtherBCBS