Provider Demographics
NPI:1275588485
Name:GOLDSTRAJ, HUGO D (MD)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:D
Last Name:GOLDSTRAJ
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 1:10855 SW 72 STREET SUITE 24
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-596-7396
Mailing Address - Fax:
Practice Address - Street 1:10855 SW 72 STREET SUITE 24
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-596-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME058165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11889Medicare ID - Type Unspecified