Healthcare Provider Details

I. General information

NPI: 1316937485
Provider Name (Legal Business Name): DEMETRIOS GONIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DEMETRIOS GONIS INC.

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 N HIGHWAY 1
COCOA FL
32927-5092
US

IV. Provider business mailing address

290 NICHOLAS PKWY NW SUITE 1
CAPE CORAL FL
33991-3804
US

V. Phone/Fax

Practice location:
  • Phone: 321-305-6965
  • Fax:
Mailing address:
  • Phone: 239-573-1152
  • Fax: 239-573-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME53510
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME53510
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: