Provider Demographics
NPI:1205920097
Name:GABRIEL NOVOA JR MD PA
Entity type:Organization
Organization Name:GABRIEL NOVOA JR MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:NOVOA-VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-596-4465
Mailing Address - Street 1:7101 SW 99TH AVE
Mailing Address - Street 2:STE 109-A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4661
Mailing Address - Country:US
Mailing Address - Phone:305-596-4465
Mailing Address - Fax:305-596-4495
Practice Address - Street 1:7101 SW 99TH AVE
Practice Address - Street 2:STE 109-A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4661
Practice Address - Country:US
Practice Address - Phone:305-596-4465
Practice Address - Fax:305-596-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83960208D00000X
FLME18212207Q00000X
FLME039500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7629Medicare ID - Type UnspecifiedGROUP NUMBER