Provider Demographics
NPI:1336674431
Name:PEZZI, TODD A (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:PEZZI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1860 BOY SCOUT DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2119
Mailing Address - Country:US
Mailing Address - Phone:239-215-1180
Mailing Address - Fax:239-215-1179
Practice Address - Street 1:25243 ELEMENTARY WAY
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7898
Practice Address - Country:US
Practice Address - Phone:239-317-2772
Practice Address - Fax:239-676-7637
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2022-07-20
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Provider Licenses
StateLicense IDTaxonomies
FLME1534102085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114722000Medicaid
FLA2YX3OtherFL BLUE
PJ770OtherMEDICARE