Provider Demographics
NPI:1013907187
Name:PHYSICIAN HEALTHCARE PROFESSIONALS OF FLORIDA INC
Entity type:Organization
Organization Name:PHYSICIAN HEALTHCARE PROFESSIONALS OF FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-637-1076
Mailing Address - Street 1:1107 W MARION AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5372
Mailing Address - Country:US
Mailing Address - Phone:941-637-1076
Mailing Address - Fax:941-637-7226
Practice Address - Street 1:1107 W MARION AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5372
Practice Address - Country:US
Practice Address - Phone:941-637-1076
Practice Address - Fax:941-637-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4735OtherMEDICARE GROUP
FL07411OtherBCBS
FLP00097605OtherRAILROAD MEDICARE
FL98380OtherBCBS GROUP