Provider Demographics
NPI:1700973153
Name:GUILLERMO P GUBBINS MD PA
Entity Type:Organization
Organization Name:GUILLERMO P GUBBINS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-854-2621
Mailing Address - Street 1:3661 S MIAMI AVE
Mailing Address - Street 2:1006
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:1006
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4236
Practice Address - Country:US
Practice Address - Phone:305-854-2621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65439207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336148972OtherNPI
FL375047700Medicaid
FL375047700Medicaid
1336148972OtherNPI