Provider Demographics
NPI:1235211335
Name:EPHTIMIOS, ISSA E (MD)
Entity Type:Individual
Prefix:
First Name:ISSA
Middle Name:E
Last Name:EPHTIMIOS
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 1:2411 EXECUTIVE PLAZA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8286
Mailing Address - Country:US
Mailing Address - Phone:850-912-8433
Mailing Address - Fax:850-912-8584
Practice Address - Street 1:2411 EXECUTIVE PLAZA RD
Practice Address - Street 2:SUITE A
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8286
Practice Address - Country:US
Practice Address - Phone:850-912-8433
Practice Address - Fax:850-912-8584
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101155207RI0200X
TX41480 (FTL)207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000759100Medicaid
FL000759100Medicaid