Provider Demographics
NPI:1205858958
Name:KATZ, ERIC H (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:H
Last Name:KATZ
Suffix:
Gender:M
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:PO BOX 919045
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9045
Mailing Address - Country:US
Mailing Address - Phone:321-729-9493
Mailing Address - Fax:321-768-6043
Practice Address - Street 1:1340 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3246
Practice Address - Country:US
Practice Address - Phone:321-729-9493
Practice Address - Fax:321-768-6043
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58208207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC59247Medicare UPIN
FLE3770Medicare ID - Type Unspecified