Healthcare Provider Details

I. General information

NPI: 1346245917
Provider Name (Legal Business Name): EDWARD G IZZO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 HAVERFORD AVE STE 105
SUN CITY CENTER FL
33573-5200
US

IV. Provider business mailing address

1901 HAVERFORD AVE STE 105
SUN CITY CENTER FL
33573-5200
US

V. Phone/Fax

Practice location:
  • Phone: 813-258-4533
  • Fax: 813-258-4733
Mailing address:
  • Phone: 813-258-4533
  • Fax: 813-258-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME0060860
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME0060860
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME0060860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: