Provider Demographics
NPI:1538312483
Name:CUDEMUS DESEDA, GASTON ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:GASTON
Middle Name:ALBERTO
Last Name:CUDEMUS DESEDA
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:PO BOX 26067
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84126-0067
Mailing Address - Country:US
Mailing Address - Phone:239-624-0400
Mailing Address - Fax:
Practice Address - Street 1:399 9TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5820
Practice Address - Country:US
Practice Address - Phone:239-624-4200
Practice Address - Fax:239-624-4241
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143322207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4KXIROtherBCBS
FL106240800Medicaid