Provider Demographics
NPI:1497146468
Name:DUARTE, GLADYS MARIA (MD)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:MARIA
Last Name:DUARTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:300-500-2000
Mailing Address - Fax:
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 930
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6812
Practice Address - Country:US
Practice Address - Phone:352-750-2108
Practice Address - Fax:352-750-1836
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN 662208D00000X
FLME162189208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL128435000Medicaid