Provider Demographics
NPI:1932145323
Name:EGOZI, ERIC ISAAC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ISAAC
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 1:1608 GULF TO BAY BLVD.
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755
Mailing Address - Country:US
Mailing Address - Phone:727-461-5872
Mailing Address - Fax:727-449-2486
Practice Address - Street 1:1608 GULF TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755
Practice Address - Country:US
Practice Address - Phone:727-461-5872
Practice Address - Fax:727-449-2486
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93030208200000X, 2086S0122X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL613486900OtherUS DEPT 0F LABOR
FL276446600Medicaid
FL28794OtherBCBS
FL276446600Medicaid
FL613486900OtherUS DEPT 0F LABOR