Organization Name: | GAYNOR MEDICAL PRACTICE |
NPI Number: | 1902210172 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT GAYNOR (OWNER) |
Mailing Address: | 10 W Grove Ave Suite 108 Lake Wales |
State: | FL US |
Postal Code: | 338534516 |
Phone Number: | 4073255227 |
Fax Number: | |
NPI Enumeration Date: | 06/16/2014 |
NPI Last Update Date: | 06/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |