Provider Demographics
NPI:1619278025
Name:GONZALEZ, EVGUENIA (DPM)
Entity Type:Individual
Prefix:
First Name:EVGUENIA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 SWIFT RD STE F
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5139
Mailing Address - Country:US
Mailing Address - Phone:941-921-3000
Mailing Address - Fax:
Practice Address - Street 1:8108 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3103
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3509213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGH026ZMedicare UPIN