Provider Demographics
NPI:1841578242
Name:HURTADO GOMEZ, GABRIEL ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:ALEXANDER
Last Name:HURTADO GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1012 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1015
Mailing Address - Country:US
Mailing Address - Phone:407-423-1039
Mailing Address - Fax:407-425-2347
Practice Address - Street 1:1012 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1015
Practice Address - Country:US
Practice Address - Phone:407-423-1039
Practice Address - Fax:407-425-2347
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24097207RI0200X
FLME147533207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07876772Medicaid