Healthcare Provider Details

I. General information

NPI: 1033174644
Provider Name (Legal Business Name): EMILIO J GOMEZ-MADRAZO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 SUNSET DR STE 408
SOUTH MIAMI FL
33143-4860
US

IV. Provider business mailing address

6280 SUNSET DR STE 408
SOUTH MIAMI FL
33143-4860
US

V. Phone/Fax

Practice location:
  • Phone: 305-441-7999
  • Fax: 305-441-8020
Mailing address:
  • Phone: 305-441-7999
  • Fax: 305-441-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME67905
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME67905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: