Provider Demographics
NPI:1750028932
Name:BRETON GAMIOTEA, RAUL (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:BRETON GAMIOTEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 S MILITARY TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7509
Mailing Address - Country:US
Mailing Address - Phone:561-835-5001
Mailing Address - Fax:954-400-3005
Practice Address - Street 1:2601 S MILITARY TRL STE 1
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7509
Practice Address - Country:US
Practice Address - Phone:561-835-5001
Practice Address - Fax:954-400-3005
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
FLACN1534208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program