Provider Demographics
NPI:1407990856
Name:LUDERGNANI, GUIDO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUIDO
Middle Name:
Last Name:LUDERGNANI
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 1:1221 W LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1857
Mailing Address - Country:US
Mailing Address - Phone:850-469-3500
Mailing Address - Fax:850-595-1400
Practice Address - Street 1:1221 W LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1857
Practice Address - Country:US
Practice Address - Phone:850-469-3500
Practice Address - Fax:850-595-1400
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020076892084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277993500Medicaid
MO205834302Medicaid
BK647ZMedicare PIN