MEDICARE: DR. ROMAN AMABLE GASTESI M.D.

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	207RX0202X	Medical Oncology Physician	ME17960	FL

General Provider Information

NPI Number	:	1932132586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMAN AMABLE GASTESI M.D.

Provider Business Mailing Address
First Line	:	816 NE 20TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3036
Country	:	US
Telephone Number	:	954-463-0070
Fax Number	:	954-463-7014

Provider Business Practice Location Address
First Line	:	816 NE 20TH AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33304-3036
Country	:	US
Telephone Number	:	954-463-0070
Fax Number	:	954-463-7014

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/08/2007

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