Provider Demographics
NPI:1477714293
Name:ERIC EGOZI MD PL
Entity Type:Organization
Organization Name:ERIC EGOZI MD PL
Other - Org Name:EGOZI PLASTIC SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-461-5872
Mailing Address - Street 1:1608 GULF TO BAY BLVD.
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755
Mailing Address - Country:US
Mailing Address - Phone:727-461-5872
Mailing Address - Fax:727-449-2486
Practice Address - Street 1:1608 GULF TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755
Practice Address - Country:US
Practice Address - Phone:727-461-5872
Practice Address - Fax:727-449-2486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93030208200000X, 2086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDS6582OtherRAILRAOD MEDICARE
FL40356OtherBCBS
FL613486900OtherUS DOL
FLDS6582OtherRAILRAOD MEDICARE