Provider Demographics
NPI:1780649293
Name:EGOZI, LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:EGOZI
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 1:21097 NE 27TH CT STE 335
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1247
Mailing Address - Country:US
Mailing Address - Phone:305-534-2908
Mailing Address - Fax:305-674-8353
Practice Address - Street 1:21097 NE 27TH CT STE 335
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1247
Practice Address - Country:US
Practice Address - Phone:305-534-2908
Practice Address - Fax:305-674-8353
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062189208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372576600Medicaid
FL17752Medicare ID - Type Unspecified
FL372576600Medicaid