Provider Demographics
NPI:1003076993
Name:GOZDANOVIC, SUZANNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MARIE
Last Name:GOZDANOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:LIEBLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1301 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-3120
Mailing Address - Country:US
Mailing Address - Phone:727-584-7706
Mailing Address - Fax:727-585-3829
Practice Address - Street 1:1301 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3120
Practice Address - Country:US
Practice Address - Phone:727-584-7706
Practice Address - Fax:727-585-3829
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113229208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006113600Medicaid
FL9172863OtherAETNA
FL14L6NOtherBCBS
FL1092607OtherCAREPLUS
FL6222178OtherCIGNA
FL6222178OtherCIGNA