Provider Demographics
NPI:1386723567
Name:PLASENCIA, GUSTAVO (MD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:PLASENCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9195 SUNSET DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3452
Mailing Address - Country:US
Mailing Address - Phone:786-466-6960
Mailing Address - Fax:305-279-1994
Practice Address - Street 1:9195 SUNSET DR
Practice Address - Street 2:SUITE 230
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3452
Practice Address - Country:US
Practice Address - Phone:786-466-6960
Practice Address - Fax:305-279-1994
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0031262208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63687Medicare UPIN