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General NPI Number Information
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NPI Number | 1164670030
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Entity Type | Individual
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Provider Name | JON ALLEN GOZDANOVIC MD
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Gender | Male
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 701 6TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4891
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Country | US
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Telephone | 321-841-2335
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Fax |
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Provider Business Mailing Address
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Address Line | 701 6TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4891
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Country | US
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Telephone | 321-841-2335
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35-093811
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | APPROVAL LETTER PEND
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME 116008
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License Number State | FL
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