Healthcare Provider Details

I. General information

NPI: 1386628097
Provider Name (Legal Business Name): JON K. GUBEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

1801S PERIMETER RD 180
FORT LAUDERDALE FL
33309-7140
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-5500
  • Fax:
Mailing address:
  • Phone: 954-839-8080
  • Fax: 954-839-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME53318
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME53318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: