Provider Demographics
NPI:1912128646
Name:ROSSIDIS, GEORGIOS (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIOS
Middle Name:
Last Name:ROSSIDIS
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 1:960 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1347
Mailing Address - Country:US
Mailing Address - Phone:727-821-8101
Mailing Address - Fax:727-825-1357
Practice Address - Street 1:4600 SW 46TH CT STE 340
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5782
Practice Address - Country:US
Practice Address - Phone:352-291-0239
Practice Address - Fax:352-291-0254
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME113218208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006106800Medicaid
FLGI786ZMedicare PIN
FL006106800Medicaid