Healthcare Provider Details

I. General information

NPI: 1649427113
Provider Name (Legal Business Name): GUSTAVO PEDRO OBREGON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 S MIAMI AVE
MIAMI FL
33129-1516
US

IV. Provider business mailing address

2041 S MIAMI AVE
MIAMI FL
33129-1516
US

V. Phone/Fax

Practice location:
  • Phone: 305-285-1334
  • Fax:
Mailing address:
  • Phone: 305-285-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME 31232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: