Provider Demographics
NPI:1346347887
Name:GORDILLO, MANUEL E (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:E
Last Name:GORDILLO
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 1:1425 S OSPREY AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2900
Mailing Address - Country:US
Mailing Address - Phone:941-366-9060
Mailing Address - Fax:941-953-7076
Practice Address - Street 1:1425 S OSPREY AVE
Practice Address - Street 2:STE 1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2900
Practice Address - Country:US
Practice Address - Phone:941-366-9060
Practice Address - Fax:941-953-7076
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062215207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17711OtherBCBS FL
FL370875600Medicaid
FL17711OtherBCBS FL
FL370875600Medicaid