Provider Demographics
NPI:1164735502
Name:GAZTAMBIDE-RODRIGUEZ, HERMAN GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:GABRIEL
Last Name:GAZTAMBIDE-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HERMAN
Other - Middle Name:GABRIEL
Other - Last Name:GAZTAMBIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10000 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3400
Mailing Address - Country:US
Mailing Address - Phone:321-841-7856
Mailing Address - Fax:321-842-0436
Practice Address - Street 1:10000 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3400
Practice Address - Country:US
Practice Address - Phone:321-841-7856
Practice Address - Fax:321-842-0436
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263170207RC0200X, 207RP1001X
FLME132664207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021124800Medicaid