Provider Demographics
NPI:1922218841
Name:GASCON, JOSE ALEXEI (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALEXEI
Last Name:GASCON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10725 NW 58TH ST STE C-7
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2801
Mailing Address - Country:US
Mailing Address - Phone:305-629-9644
Mailing Address - Fax:305-629-9630
Practice Address - Street 1:10725 NW 58TH ST STE C-7
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2801
Practice Address - Country:US
Practice Address - Phone:305-629-9644
Practice Address - Fax:305-629-9630
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001367200Medicaid
CH868ZMedicare PIN