Provider Demographics
NPI:1356300867
Name:IGEL, GUSTAVE STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVE
Middle Name:STEPHEN
Last Name:IGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 LAKEVIEW RD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3355
Mailing Address - Country:US
Mailing Address - Phone:727-461-7611
Mailing Address - Fax:727-461-2860
Practice Address - Street 1:600 LAKEVIEW RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3355
Practice Address - Country:US
Practice Address - Phone:727-461-7611
Practice Address - Fax:727-461-2860
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0038869207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065777800Medicaid
FL065777800Medicaid
FL62335Medicare ID - Type Unspecified