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General NPI Number Information
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NPI Number | 1912450289
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Entity Type | Organization
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Legal Business Name | GOUSSE UROLOGY, LLC
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 1951 SW 172ND AVE SUITE 305
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City | MIRAMAR
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State | FL
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Zip | 33029-5593
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Country | US
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Telephone | 954-362-2720
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Fax |
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Provider Business Mailing Address
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Address Line | 1951 SW 172ND AVE SUITE 305
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City | MIRAMAR
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State | FL
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Zip | 33029-5593
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MGRM
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Name | DR. ANGELO GOUSSE
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Credential | M.D.
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Telephone | 954-362-2720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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