Provider Demographics
NPI:1881689735
Name:COSTA, GABRIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:A
Last Name:COSTA
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 1:2974 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2827
Mailing Address - Country:US
Mailing Address - Phone:305-631-3000
Mailing Address - Fax:305-631-3006
Practice Address - Street 1:2974 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2827
Practice Address - Country:US
Practice Address - Phone:305-631-3000
Practice Address - Fax:305-631-3006
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2015-07-10
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
FLME0048123207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044932600Medicaid
FL044932600Medicaid
FL044932600Medicaid