Healthcare Provider Details

I. General information

NPI: 1316798564
Provider Name (Legal Business Name): PANAGIOTIS EVANGELOS GAVATHAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

IV. Provider business mailing address

3908 SHAMROCK W
TALLAHASSEE FL
32309-2230
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-7900
  • Fax:
Mailing address:
  • Phone: 954-560-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: