Provider Demographics
NPI:1912012873
Name:STERN, GUSTAVO FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:FERNANDO
Last Name:STERN
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 1:864 CENTRAL BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7539
Mailing Address - Country:US
Mailing Address - Phone:956-541-8361
Mailing Address - Fax:956-541-9848
Practice Address - Street 1:864 CENTRAL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7539
Practice Address - Country:US
Practice Address - Phone:956-541-8361
Practice Address - Fax:956-541-9848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C22253Medicare UPIN
00BA99Medicare ID - Type Unspecified