Provider Demographics
NPI:1063460756
Name:LEDO-SANCHEZ, GUSTAVO G (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:G
Last Name:LEDO-SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2387 W 68TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6890
Mailing Address - Country:US
Mailing Address - Phone:305-557-8486
Mailing Address - Fax:305-557-0110
Practice Address - Street 1:2387 WEST 68 ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-557-8486
Practice Address - Fax:305-557-1025
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053137207Q00000X, 208D00000X
FLME 0053137208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048721000Medicaid
FLME 0053137OtherMEDICAL LICENSE
FLME 0053137OtherMEDICAL LICENSE
FLBL1055018OtherDEA #
FLME 0053137OtherMEDICAL LICENSE