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NPI Code Detail

MEDICARE: FAUSTO RONALD BURGOS M.D.

MEDICARE: FAUSTO RONALD BURGOS M.D.
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 PhysicianME0062672FL

Other Identifiers

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

General Provider Information

NPI Number : 1679503486
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAUSTO RONALD BURGOS M.D.
Provider Business Mailing Address
First Line : 4034 GREENLEAF DR
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-9150
Country : US
Telephone Number : 407-242-0293
Fax Number :
Provider Business Practice Location Address
First Line : 12301 LAKE UNDERHILL RD STE 215
Second Line :
City : ORLANDO
State : FL
Zip : 32828-4511
Country : US
Telephone Number : 321-235-0692
Fax Number : 321-235-0694
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 03/17/2025

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Directions to “ FAUSTO RONALD BURGOS M.D.” Practice Location

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