Individual
DR. GUSTAVO ALBERTO DE JESUS-GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5325 US HWY 98 S, LAKELAND, FL 33812-3381
(863) 937-3139
(863) 937-3147
Mailing address
PO BOX 1328, HIGHLAND CITY, FL 33846-1328
(863) 937-3139
(863) 937-3147
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
25992
PR
208600000X
Surgery Physician
ME112008
FL
2086S0129X
Vascular Surgery Physician
Primary
ME112008
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113606000
—
FL
01
—
14JQ2
BCBS OF FLORIDA
FL
Enumeration date
06/19/2007
Last updated
10/16/2025
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