Healthcare Provider Details

I. General information

NPI: 1164670030
Provider Name (Legal Business Name): JON ALLEN GOZDANOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 6TH ST S
ST PETERSBURG FL
33701-4891
US

IV. Provider business mailing address

701 6TH ST S
ST PETERSBURG FL
33701-4891
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-2335
  • Fax:
Mailing address:
  • Phone: 321-841-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35-093811
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberAPPROVAL LETTER PEND
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME 116008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: