Provider Demographics
NPI:1306810486
Name:DUARTE, IGNACIO GUSTAVO (MD)
Entity type:Individual
Prefix:
First Name:IGNACIO
Middle Name:GUSTAVO
Last Name:DUARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6006 49TH ST N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2148
Mailing Address - Country:US
Mailing Address - Phone:727-490-5040
Mailing Address - Fax:727-490-5045
Practice Address - Street 1:270 S MOON AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5711
Practice Address - Country:US
Practice Address - Phone:813-571-9988
Practice Address - Fax:813-571-9922
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME93214208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01293773OtherRR MEDICARE
FL004131200Medicaid
FLH85442Medicare UPIN
FL004131200Medicaid
FL4372247OtherCIGNA
FL16044ZMedicare PIN
FL1086990OtherAETNA
FL16044OtherBCBS
FL134223953OtherHUMANA
FL295077OtherSTAYWELL
FL272756100Medicaid
FL295077OtherWELLCARE