Provider Demographics
NPI:1811053887
Name:VENUTO, GARY (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:VENUTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 HUEY ST
Mailing Address - Street 2:APARTMENT B15
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-4665
Mailing Address - Country:US
Mailing Address - Phone:352-748-5745
Mailing Address - Fax:
Practice Address - Street 1:775 HUEY ST
Practice Address - Street 2:APARTMENT B15
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4665
Practice Address - Country:US
Practice Address - Phone:352-748-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT266371-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B35477Medicare UPIN