Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME113229 | FL |
Y | 208600000X | Surgeon | ME113229 | FL |
N | 2086S0129X | Vascular Surgeon | ME113229 | FL |
NPI | 1003076993 |
---|---|
Provider Name | Dr. Suzanne Marie Gozdanovic |
First Address | Largo, FL 33770-3120 |
Second Address | Largo, FL 33770-3120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2008 |
Last Update Date | 10/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006113600 | (05) | FL |
1092607 | CAREPLUS (01) | FL |
14L6N | BCBS (01) | FL |
6222178 | CIGNA (01) | FL |
9172863 | AETNA (01) | FL |