Provider Demographics
NPI:1255483822
Name:GOROVOY, STACEY EVE (MD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:EVE
Last Name:GOROVOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:EVE
Other - Last Name:KUNC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12381 S CLEVELAND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3852
Mailing Address - Country:US
Mailing Address - Phone:239-939-1444
Mailing Address - Fax:239-936-7710
Practice Address - Street 1:12381 S CLEVELAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3893
Practice Address - Country:US
Practice Address - Phone:239-939-1444
Practice Address - Fax:239-936-7710
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112136207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005483400Medicaid