Provider Demographics
NPI:1417367343
Name:'GARY T GOSSINGER MD PA
Entity type:Organization
Organization Name:'GARY T GOSSINGER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GOSSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-371-6402
Mailing Address - Street 1:2830 NW 41ST ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6667
Mailing Address - Country:US
Mailing Address - Phone:352-371-6402
Mailing Address - Fax:352-371-6403
Practice Address - Street 1:2830 NW 41ST ST
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6667
Practice Address - Country:US
Practice Address - Phone:352-371-6402
Practice Address - Fax:352-371-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00253832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50025Medicare UPIN