| Doctor Name: | DR. GUSTAVO A FONSECA |
| NPI Number: | 1063478766 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME0057124 |
| Business Practice Address: | 521 N Lecanto Hwy Florida Cancer Specialists P L Lecanto, FL - 344619187 |
| Business Phone Number: | 3527460707 |
| Business Fax Number: | 3527466333 |
| Mailing Address: | 4371 Veronica S Shoemaker Blvd, Attn: Credentialing FORT MYERS |
| State: | FL |
| Postal Code: | 339162216 |
| Phone Number: | 2392748200 |
| Fax Number: | 2392783350 |
| NPI Enumeration Date: | 04/22/2006 |
| NPI Last Update Date: | 02/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RH0003X |
| License Number: | ME0057124 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Hematology & Oncology |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |