Healthcare Provider Details

I. General information

NPI: 1497875868
Provider Name (Legal Business Name): EUGENE LUCAS RIZZO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 PARK ST N STE 7W
ST PETERSBURG FL
33709-7042
US

IV. Provider business mailing address

390 PINELLAS BAYWAY S APT A
TIERRA VERDE FL
33715-1915
US

V. Phone/Fax

Practice location:
  • Phone: 727-202-8140
  • Fax: 727-202-8252
Mailing address:
  • Phone: 318-422-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME151604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: