Provider Demographics
NPI:1134129505
Name:VASILOUDES, PANAYIOTIS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:PANAYIOTIS
Middle Name:
Last Name:VASILOUDES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:PANOS
Other - Middle Name:
Other - Last Name:VASILOUDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:5210 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4518
Mailing Address - Country:US
Mailing Address - Phone:813-882-9986
Mailing Address - Fax:813-341-3259
Practice Address - Street 1:5210 WEBB RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4518
Practice Address - Country:US
Practice Address - Phone:813-882-9986
Practice Address - Fax:813-882-9849
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78436207ND0101X, 207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269815300Medicaid
FL46810ZMedicare ID - Type Unspecified