Provider Demographics
NPI:1699730796
Name:GEORGE A GAMOURAS MD PA
Entity type:Organization
Organization Name:GEORGE A GAMOURAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAMOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-304-9720
Mailing Address - Street 1:6376 PINE RIDGE RD STE 380
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3905
Mailing Address - Country:US
Mailing Address - Phone:239-304-9720
Mailing Address - Fax:239-304-9609
Practice Address - Street 1:6376 PINE RIDGE RD STE 380
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3905
Practice Address - Country:US
Practice Address - Phone:239-304-9720
Practice Address - Fax:239-304-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDG2214OtherRR MEDICARE
FL=========OtherTAX ID
FLAD047Medicare PIN