Provider Demographics
NPI:1861689960
Name:VALDEZ FIGUEROA, GERSON D (MD)
Entity Type:Individual
Prefix:DR
First Name:GERSON
Middle Name:D
Last Name:VALDEZ FIGUEROA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 W JETTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5112
Mailing Address - Country:US
Mailing Address - Phone:954-844-5074
Mailing Address - Fax:
Practice Address - Street 1:3714 W JETTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5112
Practice Address - Country:US
Practice Address - Phone:954-844-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60088143207R00000X, 207RC0000X, 207RI0011X
WI71971207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500695985Medicaid
WA2049371Medicaid
WAG8947797Medicare PIN