MEDICARE: GINO ALBERTO JR. DO

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	207P00000X	Emergency Medicine Physician	02001921A	IN

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
2	000000112218	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1629188388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINO ALBERTO JR. DO

Provider Business Mailing Address
First Line	:	12831 NW CINNAMON WAY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-4880
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12831 NW CINNAMON WAY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-4880
Country	:	US
Telephone Number	:	772-807-5531
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/22/2016

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Directions to “ GINO ALBERTO JR. DO” Practice Location

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