Provider Demographics
NPI:1639342926
Name:WIDI, GABRIEL ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ANTONIO
Last Name:WIDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GABRIEL
Other - Middle Name:ANTONIO
Other - Last Name:WIDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:777 E 25TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3849
Mailing Address - Country:US
Mailing Address - Phone:786-534-7751
Mailing Address - Fax:844-361-9351
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:786-534-7751
Practice Address - Fax:844-361-9351
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122876207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME122876OtherMEDICAL LICENSE