Provider Demographics
NPI:1447247341
Name:ZUAZU, GREGORIO B (MD)
Entity type:Individual
Prefix:
First Name:GREGORIO
Middle Name:B
Last Name:ZUAZU
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 1:6039 COLLINS AVENUE
Mailing Address - Street 2:APT 1115
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2252
Mailing Address - Country:US
Mailing Address - Phone:713-542-4522
Mailing Address - Fax:
Practice Address - Street 1:6039 COLLINS AVENUE
Practice Address - Street 2:APT 1115
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2252
Practice Address - Country:US
Practice Address - Phone:713-542-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME391372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004187500Medicaid
FL004187500Medicaid
E52127Medicare UPIN
TX136979515OtherCSHCN
E52127Medicare UPIN
TX81R595Medicare ID - Type Unspecified
TX136979514Medicaid