Provider Demographics
NPI:1861400459
Name:GAYLES, RICHARD E (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:GAYLES
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 1:9145 NARCOOSSEE RD
Mailing Address - Street 2:SUITE A200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-5768
Mailing Address - Country:US
Mailing Address - Phone:407-412-5030
Mailing Address - Fax:407-601-7946
Practice Address - Street 1:9145 NARCOOSSEE RD
Practice Address - Street 2:SUITE A200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-5768
Practice Address - Country:US
Practice Address - Phone:407-412-5030
Practice Address - Fax:407-601-7946
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73164208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1074660OtherCAQH
FL41862OtherBCBS
1861400459OtherNPI
FL6754544OtherCIGNA
FLE0009YMedicare PIN
FLG51073Medicare UPIN
FL41862OtherBCBS