Provider Demographics
NPI:1255563284
Name:GREENBERG, EUGENIA ALEXA (DO)
Entity type:Individual
Prefix:DR
First Name:EUGENIA
Middle Name:ALEXA
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EUGENIA
Other - Middle Name:ALEXA
Other - Last Name:SAMOILOVA-WAGONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-917-4896
Practice Address - Fax:941-917-6884
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-09
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine