Healthcare Provider Details

I. General information

NPI: 1912450289
Provider Name (Legal Business Name): GOUSSE UROLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 SW 172ND AVE SUITE 305
MIRAMAR FL
33029-5593
US

IV. Provider business mailing address

1951 SW 172ND AVE SUITE 305
MIRAMAR FL
33029-5593
US

V. Phone/Fax

Practice location:
  • Phone: 954-362-2720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELO GOUSSE
Title or Position: MGRM
Credential: M.D.
Phone: 954-362-2720