Gustavo F Ros MD PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GUSTAVO F ROS MD PA

Practice address

965 Mar Walt Dr
Fort Walton Beach, FL 32547-6706

Phone

(850) 863-3199

Fax

(850) 863-3196

NPI assigned

Jun 19, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gustavo F Ros, MDNPI 1912902982

Title

Owner

Phone

(850) 863-3199

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gustavo F Ros, M.D.

  • Internal Medicine Physician
  • Fort Walton Beach, FL
  • NPI 1912902982

  FL, Internal Medicine

  Medicare reassignment NPD Authorized official
• Penny R Frantz, ARNP

  • Family Nurse Practitioner
  • Fort Walton Beach, FL
  • NPI 1235112939
  NPD (past)
• Lee David Ettinger, M.D.

  • Pulmonary Disease Physician
  • Montrose, CO
  • NPI 1235112129
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694563200000",
    "number": "1548754963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-863-3199",
            "fax_number": "850-863-3196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "965 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-863-3199",
            "fax_number": "850-863-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUSTAVO F ROS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-19",
        "last_updated": "2023-09-13",
        "status": "A",
        "authorized_official_last_name": "ROS",
        "authorized_official_first_name": "GUSTAVO",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-863-3199",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Teresa M Gutierrez, OT CHT
• Christine Drylak Guy, M.S., CMHP
• Victoria Guynn
• Adam Justin Haas
• Corey James Hadley, RBT

• All providers in Fort Walton Beach, FL
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.