Provider Demographics
NPI:1508050048
Name:CARDENAS GOMEZ, EDGAR IVON (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:IVON
Last Name:CARDENAS GOMEZ
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 1:86 W UNDERWOOD ST
Mailing Address - Street 2:MP 80
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2008
Mailing Address - Country:US
Mailing Address - Phone:888-912-3648
Mailing Address - Fax:321-841-4085
Practice Address - Street 1:86 W UNDERWOOD ST
Practice Address - Street 2:MP 80
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2008
Practice Address - Country:US
Practice Address - Phone:888-912-3648
Practice Address - Fax:321-841-4085
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7236207R00000X
FLME113603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME113603OtherMEDICAL LICENSE
FL005961600Medicaid
FLGI322ZMedicare PIN