Provider Demographics
NPI:1821028259
Name:GOUSSE, ANGELO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:E
Last Name:GOUSSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-362-2720
Practice Address - Fax:954-362-2762
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0069645208800000X
FLME696452088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0001331OtherJMH HEALTH
FL2538938-00Medicaid
FL0717123OtherCIGNA
FL244190OtherAVMED
FL5323586OtherAETNA
FLQMP000003983934OtherMOLINA HEALTH
FL24166OtherMEDICA
FL185336OtherUNIVERSAL HEALTHCARE
FLF00197988703OtherUNITED HEALTHCARE
FLP0004230OtherFLORIDA HEALTHCARE PLUS
FL1034380OtherCAREPLUS/NEW CENTURY
FLP941893OtherOPTUMIM
FLP01048791OtherRAILROAD MEDICARE
FL41461OtherBCBS FL
FLP01715251OtherSIMPLY HEALTHCARE
FLP1001081OtherFREEDOM HEALTH
FL1193064OtherWELLCARE
FLPRL0000027914OtherPREFERRED MEDICAL PLAN
FLP1001081OtherFREEDOM HEALTH
FL41461OtherBCBS FL
FL5323586OtherAETNA
FL41461XMedicare PIN