Provider Demographics
NPI:1447241047
Name:ZONANA, ELI (MD)
Entity Type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:ZONANA
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:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-332-0417
Mailing Address - Fax:239-334-9417
Practice Address - Street 1:930 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4444
Practice Address - Country:US
Practice Address - Phone:239-332-0417
Practice Address - Fax:863-675-1346
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60727208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF01272Medicare UPIN
FL12991XMedicare ID - Type Unspecified