Healthcare Provider Details

I. General information

NPI: 1053750661
Provider Name (Legal Business Name): R GASTESI, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 N FEDERAL HWY
FORT LAUDERDALE FL
33306-1424
US

IV. Provider business mailing address

2780 N FEDERAL HWY
FORT LAUDERDALE FL
33306-1424
US

V. Phone/Fax

Practice location:
  • Phone: 954-564-1111
  • Fax:
Mailing address:
  • Phone: 954-564-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License NumberME0017960
License Number StateFL

VIII. Authorized Official

Name: DR. ROMAN GASTESI
Title or Position: PRESIDENT
Credential: MD
Phone: 954-298-1273