Provider Demographics
NPI:1912902982
Name:ROS, GUSTAVO F (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:F
Last Name:ROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:965 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6759
Mailing Address - Country:US
Mailing Address - Phone:850-797-3482
Mailing Address - Fax:850-897-1022
Practice Address - Street 1:965 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6759
Practice Address - Country:US
Practice Address - Phone:850-863-3199
Practice Address - Fax:850-863-3196
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD27970207P00000X
FLME88887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267192100Medicaid
FL268405500Medicaid
AL109024Medicaid
AL1912902982Medicaid
FL268405500Medicaid
FL267192100Medicaid
FLH97921Medicare UPIN