MEDICARE: DR. LUIS GABRIEL IZQUIERDO 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
1	207Y00000X	Otolaryngology Physician	ME101557	FL
2	207Y00000X	Otolaryngology Physician	69013	GA

General Provider Information

NPI Number	:	1780802447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS GABRIEL IZQUIERDO M.D.

Provider Business Mailing Address
First Line	:	7251 UNIVERSITY BLVD
Second Line	:	SUITE 300
City	:	WINTER PARK
State	:	FL
Zip	:	32792-8659
Country	:	US
Telephone Number	:	407-677-0099
Fax Number	:	407-677-5505

Provider Business Practice Location Address
First Line	:	7251 UNIVERSITY BLVD
Second Line	:	SUITE 300
City	:	WINTER PARK
State	:	FL
Zip	:	32792-8659
Country	:	US
Telephone Number	:	407-677-0099
Fax Number	:	407-677-5505

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	06/22/2015

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