Provider Demographics
NPI:1205894391
Name:CABAN, GREGORIO (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:
Last Name:CABAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20489 NW 12TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2431
Mailing Address - Country:US
Mailing Address - Phone:305-849-1677
Mailing Address - Fax:
Practice Address - Street 1:2000 NW 87TH AVE STE 217
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2657
Practice Address - Country:US
Practice Address - Phone:305-396-8731
Practice Address - Fax:305-396-8732
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3185208D00000X
FLPO-3185213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340584200Medicaid
FLV-11036Medicare UPIN
FL340584200Medicaid