MEDICARE: DR. GILBERTO MODESTO-LEBRON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	16313	PR

General Provider Information

NPI Number	:	1356303234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILBERTO MODESTO-LEBRON MD

Provider Business Mailing Address
First Line	:	3513 NW 181ST ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3437
Country	:	US
Telephone Number	:	305-917-3288
Fax Number	:

Provider Business Practice Location Address
First Line	:	3513 NW 181ST ST
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-3437
Country	:	US
Telephone Number	:	305-917-3288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	12/28/2012

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