Healthcare Provider Details

I. General information

NPI: 1194702530
Provider Name (Legal Business Name): GILBERT TEIXEIRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W HILLSBORO BLVD STE 103
DEERFIELD BEACH FL
33442-1423
US

IV. Provider business mailing address

PO BOX 4189
DEERFIELD BEACH FL
33442-4189
US

V. Phone/Fax

Practice location:
  • Phone: 954-408-8960
  • Fax: 954-408-8961
Mailing address:
  • Phone: 954-363-9582
  • Fax: 954-363-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS19135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: