Provider Demographics
NPI:1346245917
Name:IZZO, EDWARD G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:IZZO
Suffix:JR
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 1:1901 HAVERFORD AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5200
Mailing Address - Country:US
Mailing Address - Phone:813-258-4533
Mailing Address - Fax:813-258-4733
Practice Address - Street 1:1901 HAVERFORD AVE
Practice Address - Street 2:STE 105
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5200
Practice Address - Country:US
Practice Address - Phone:813-258-4533
Practice Address - Fax:813-258-4733
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00608602086S0129X, 2086S0127X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2463923OtherAETNA
FL058349900Medicaid
FL14356OtherIND BX
FL330005522OtherRR MEDICARE
FLME0060860OtherLICENSE
FL593689604OtherTAX ID
FL058349900Medicaid
FLME0060860OtherLICENSE