Provider Demographics
NPI:1306856968
Name:GIORGIS, ESAIAS W (MD)
Entity Type:Individual
Prefix:
First Name:ESAIAS
Middle Name:W
Last Name:GIORGIS
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 1:1116 TALL PINE DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2587
Mailing Address - Country:US
Mailing Address - Phone:407-880-4128
Mailing Address - Fax:
Practice Address - Street 1:440 W STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4136
Practice Address - Country:US
Practice Address - Phone:407-788-2000
Practice Address - Fax:407-788-2024
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 46718208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21812Medicare UPIN