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NPI Code Detail

MEDICARE: DR. GUSEV GONZALEZ CAMPBELL MD

MEDICARE: DR. GUSEV GONZALEZ CAMPBELL 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
1207Q00000XFamily Medicine PhysicianME 118595FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1O3111OTHERFLMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104194463
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GUSEV GONZALEZ CAMPBELL MD
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 200
Second Line :
City : MIAMI
State : FL
Zip : 33126-3168
Country : US
Telephone Number : 844-630-0700
Fax Number : 877-374-1924
Provider Business Practice Location Address
First Line : 14075 TOWN LOOP BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32837-6132
Country : US
Telephone Number : 407-438-5858
Fax Number : 407-438-7172
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2011
Last Update Date : 02/13/2026

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