Provider Demographics
NPI:1487700233
Name:DEGAMO, ELIGIO S (MD)
Entity type:Individual
Prefix:DR
First Name:ELIGIO
Middle Name:S
Last Name:DEGAMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIGIO
Other - Middle Name:S
Other - Last Name:DEGAMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2401 NORTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7904
Mailing Address - Country:US
Mailing Address - Phone:407-281-4723
Mailing Address - Fax:407-281-4723
Practice Address - Street 1:1403 MEDICAL PLAZA DR
Practice Address - Street 2:SUITES 108/109
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1000
Practice Address - Country:US
Practice Address - Phone:407-330-6500
Practice Address - Fax:407-343-1650
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 107654207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology