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General NPI Number Information
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NPI Number | 1013907187
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Entity Type | Organization
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Legal Business Name | PHYSICIAN HEALTHCARE PROFESSIONALS OF FLORIDA INC
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1107 W MARION AVE SUITE 116
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City | PUNTA GORDA
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State | FL
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Zip | 33950-5372
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Country | US
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Telephone | 941-637-1076
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Fax | 941-637-7226
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Provider Business Mailing Address
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Address Line | 1107 W MARION AVE SUITE 116
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City | PUNTA GORDA
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State | FL
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Zip | 33950-5372
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Country | US
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Telephone | 941-637-1076
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Fax | 941-637-7226
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DEMETRIOS GONIS
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Credential | M.D.
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Telephone | 941-637-1076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | FL
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