MEDICARE: GONZALO A ORIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	ME0045423	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	96767Z	OTHER	FL	MEDICARE PROVIDER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	96767	OTHER	FL	BCBSFL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083666325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GONZALO A ORIA MD

Provider Business Mailing Address
First Line	:	1696 SE HILLMOOR DR STE B
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-7699
Country	:	US
Telephone Number	:	772-337-4600
Fax Number	:	772-337-7600

Provider Business Practice Location Address
First Line	:	1696 SE HILLMOOR DR
Second Line	:	SUITE A
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-7699
Country	:	US
Telephone Number	:	772-337-4600
Fax Number	:	772-337-7600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	02/22/2020

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Directions to “ GONZALO A ORIA MD” Practice Location

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