MEDICARE: GUILLERMO L FONT MD PA

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	207Q00000X	Family Medicine Physician	ME30077	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104101963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUILLERMO L FONT MD PA

Provider Business Mailing Address
First Line	:	407 LINCOLN RD
Second Line	:	SUITE 4L
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3020
Country	:	US
Telephone Number	:	305-532-9004
Fax Number	:	305-532-4036

Provider Business Practice Location Address
First Line	:	407 LINCOLN RD
Second Line	:	SUITE 4L
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3020
Country	:	US
Telephone Number	:	305-532-9004
Fax Number	:	305-532-4036

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GUILLERMO LUIS FONT
Credential	:	MD
Telephone Number	:	305-532-9004

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	10/12/2011

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