Healthcare Provider Details

I. General information

NPI: 1003443946
Provider Name (Legal Business Name): GUSTAVO JOSE DUARTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3609
US

IV. Provider business mailing address

1400 PELHAM PKWY S
BRONX NY
10461-1197
US

V. Phone/Fax

Practice location:
  • Phone: 877-463-2010
  • Fax:
Mailing address:
  • Phone: 718-918-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME161958
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: