MEDICARE: DR. EDWARD G IZZO JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	ME0060860	FL
2	2086S0127X	Trauma Surgery Physician	ME0060860	FL
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME0060860	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	330005522	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2463923	OTHER	FL	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14356	OTHER	FL	IND BX
5	ME0060860	OTHER	FL	LICENSE
6	593689604	OTHER	FL	TAX ID

General Provider Information

NPI Number	:	1346245917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD G IZZO JR. MD

Provider Business Mailing Address
First Line	:	1901 HAVERFORD AVE
Second Line	:	STE 105
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5200
Country	:	US
Telephone Number	:	813-258-4533
Fax Number	:	813-258-4733

Provider Business Practice Location Address
First Line	:	1901 HAVERFORD AVE
Second Line	:	STE 105
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5200
Country	:	US
Telephone Number	:	813-258-4533
Fax Number	:	813-258-4733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	11/22/2017

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