Provider Demographics
NPI:1689824005
Name:FERRER, GUSTAVO (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:
Last Name:FERRER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GUSTAVO
Other - Middle Name:
Other - Last Name:FERRER-GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:701 N FEDERAL HWY # 601
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2449
Mailing Address - Country:US
Mailing Address - Phone:954-482-4747
Mailing Address - Fax:954-301-5939
Practice Address - Street 1:701 N FEDERAL HWY # 601
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2449
Practice Address - Country:US
Practice Address - Phone:954-482-4747
Practice Address - Fax:954-301-5939
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104425207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001259700Medicaid
FLCD438ZMedicare PIN