=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699931436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTONIO L. GABARDA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2008
-----------------------------------------------------
Last Update Date | 11/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 HARBOR BLVD STE 205
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-5342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-629-4660
-----------------------------------------------------
Fax | 941-629-7586
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2525 HARBOR BLVD STE 205
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-5342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-629-4660
-----------------------------------------------------
Fax | 941-629-7586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTONIO LABITAG GABARDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-629-4660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | ME45099
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------