Provider Demographics
NPI:1043505332
Name:GUMIROFF, ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:GUMIROFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALEXANDER
Other - Middle Name:
Other - Last Name:GUMIROV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-226-4650
Practice Address - Street 1:13195 METRO PKWY
Practice Address - Street 2:#6-9
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4810
Practice Address - Country:US
Practice Address - Phone:239-344-2348
Practice Address - Fax:239-479-5194
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115034207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008513300Medicaid
FLHF783ZMedicare PIN