Provider Demographics
NPI:1770501967
Name:NOVOA, GABRIEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:NOVOA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7101 SW 99TH AVE
Mailing Address - Street 2:SUITE 109-A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4661
Mailing Address - Country:US
Mailing Address - Phone:305-596-4465
Mailing Address - Fax:305-596-4495
Practice Address - Street 1:7101 SW 99TH AVE
Practice Address - Street 2:SUITE 109-A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4661
Practice Address - Country:US
Practice Address - Phone:305-596-4465
Practice Address - Fax:305-596-4495
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME039500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067695100Medicaid
FLD6737Medicare UPIN
FL067695100Medicaid