Provider Demographics
NPI:1083666325
Name:ORIA, GONZALO A (MD)
Entity Type:Individual
Prefix:
First Name:GONZALO
Middle Name:A
Last Name:ORIA
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 1:1696 SE HILLMOOR DR STE B
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7699
Mailing Address - Country:US
Mailing Address - Phone:772-337-4600
Mailing Address - Fax:772-337-7600
Practice Address - Street 1:1696 SE HILLMOOR DR
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7699
Practice Address - Country:US
Practice Address - Phone:772-337-4600
Practice Address - Fax:772-337-7600
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045423207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96767OtherBCBSFL
FL036233600Medicaid
FL96767ZOtherMEDICARE PROVIDER
D77111Medicare UPIN