Provider Demographics
NPI:1558366732
Name:LOZANO, GILBERTO A (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:A
Last Name:LOZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:320 STATE ROAD 60 E
Mailing Address - Street 2:STE 301
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-3750
Mailing Address - Country:US
Mailing Address - Phone:863-678-1400
Mailing Address - Fax:863-678-1414
Practice Address - Street 1:320 STATE ROAD 60 E
Practice Address - Street 2:STE 301
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3750
Practice Address - Country:US
Practice Address - Phone:863-678-1400
Practice Address - Fax:863-678-1414
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME84676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264841500Medicaid
FLH61240Medicare UPIN
FL264841500Medicaid
FL15553YMedicare PIN