Provider Demographics
NPI:1710076971
Name:GNIDA, EUGENE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:WILLIAM
Last Name:GNIDA
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 1:836 PRUDENTIAL DRIVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207
Mailing Address - Country:US
Mailing Address - Phone:904-348-0974
Mailing Address - Fax:904-348-5627
Practice Address - Street 1:836 PRUDENTIAL DRIVE
Practice Address - Street 2:SUITE 1400
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-348-0974
Practice Address - Fax:904-348-5627
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98333207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0001952-00Medicaid
FLK1951AOtherBPC GROUP MCR PIN
FLRES000Medicare UPIN
FL0001952-00Medicaid