Provider Demographics
NPI:1497704928
Name:GUERGUES, YOUSSEF W (MD)
Entity Type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:W
Last Name:GUERGUES
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 1:1671 N. CLYDE MORRIS BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-274-2977
Mailing Address - Fax:386-274-2966
Practice Address - Street 1:740 1/2 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3282
Practice Address - Country:US
Practice Address - Phone:386-740-1123
Practice Address - Fax:386-274-4835
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073221207L00000X, 208VP0000X
FL0073221208VP0000X
FLME73221208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259201100Medicaid
FL49975XMedicare ID - Type Unspecified
FL259201100Medicaid
49975XMedicare UPIN