Provider Demographics
NPI:1720312739
Name:GUSTAVE, WILLIAM ALFONSO (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALFONSO
Last Name:GUSTAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 817737
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33081-1737
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:561-741-5641
Practice Address - Street 1:136 JUPITER LAKES BLVD
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7180
Practice Address - Country:US
Practice Address - Phone:561-741-5591
Practice Address - Fax:561-741-5641
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2022-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 111666208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist