Provider Demographics
NPI:1760648315
Name:GUTIERREZ BORGES, GONZALO N (MD)
Entity Type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:N
Last Name:GUTIERREZ BORGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GONZALO
Other - Middle Name:NICANOR
Other - Last Name:GUTIERREZ BORGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:121 S ORANGE AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3234
Mailing Address - Country:US
Mailing Address - Phone:407-658-9687
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:920 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4914
Practice Address - Country:US
Practice Address - Phone:407-956-1920
Practice Address - Fax:407-483-5844
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00390363AS0400X
FLACN1033207Q00000X
PR19712208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX07230824OtherECFMG
TX07230824OtherECFMG