Individual
DR. THEODORE N FOTOPOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5534 GULF DR, SUITE 1, NEW PORT RICHEY, FL 34652-4000
(727) 847-3992
(727) 848-1118
Mailing address
5534 GULF DR, SUITE 1, NEW PORT RICHEY, FL 34652-4000
(727) 847-3992
(727) 848-1118
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
ME0063090
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070009211
RAILROAD MEDICARE
FL
01
—
08190
WELLCARE
FL
01
—
2017793
AETNA
FL
01
—
242931
AVMED
FL
01
—
31796
BLUE CROSS BLUE SHIELD
FL
01
—
591798817
HUMANA
FL
01
—
8550571-003
CIGNA
FL
Enumeration date
07/28/2005
Last updated
12/06/2022
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