Provider Demographics
NPI:1124014550
Name:DE CARDENAS, GASTON A (MD)
Entity Type:Individual
Prefix:DR
First Name:GASTON
Middle Name:A
Last Name:DE CARDENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-662-8316
Mailing Address - Fax:305-663-8513
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-8316
Practice Address - Fax:305-663-8513
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2010-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0024200207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053874400Medicaid
FL91927ZMedicare ID - Type Unspecified
FLD79902Medicare UPIN