MEDICARE: GUSTAVO ARTURO AVILA AMAT 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	208M00000X	Hospitalist Physician	ME149881	FL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	ME149881	FL

General Provider Information

NPI Number	:	1437655131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO ARTURO AVILA AMAT MD

Provider Business Mailing Address
First Line	:	5301 S CONGRESS AVE
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1149
Country	:	US
Telephone Number	:	877-832-2652
Fax Number	:	800-792-9021

Provider Business Practice Location Address
First Line	:	180 JFK DR STE 210
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-6641
Country	:	US
Telephone Number	:	561-548-1450
Fax Number	:	561-548-1459

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

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	11/11/2024

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