Provider Demographics
NPI:1336346881
Name:ELSAGGA, FAWZI Y (MD)
Entity type:Individual
Prefix:DR
First Name:FAWZI
Middle Name:Y
Last Name:ELSAGGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ZEAGLER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3883
Mailing Address - Country:US
Mailing Address - Phone:386-385-3043
Mailing Address - Fax:
Practice Address - Street 1:800 ZEAGLER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3883
Practice Address - Country:US
Practice Address - Phone:386-385-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1089232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFZ207ZMedicare PIN