Provider Demographics
NPI:1699931436
Name:ANTONIO L. GABARDA MD PA
Entity type:Organization
Organization Name:ANTONIO L. GABARDA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:LABITAG
Authorized Official - Last Name:GABARDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-629-4660
Mailing Address - Street 1:2525 HARBOR BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5342
Mailing Address - Country:US
Mailing Address - Phone:941-629-4660
Mailing Address - Fax:941-629-7586
Practice Address - Street 1:2525 HARBOR BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5342
Practice Address - Country:US
Practice Address - Phone:941-629-4660
Practice Address - Fax:941-629-7586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45099207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040662700Medicaid
FLAP166Medicare PIN
FL040662700Medicaid