Provider Demographics
NPI:1972704070
Name:LIENHART, GARY JO (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JO
Last Name:LIENHART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11231 LAKE LANIER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2935
Mailing Address - Country:US
Mailing Address - Phone:727-230-1576
Mailing Address - Fax:727-230-1604
Practice Address - Street 1:11231 LAKE LANIER DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-2935
Practice Address - Country:US
Practice Address - Phone:727-230-1576
Practice Address - Fax:727-230-1604
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015979207L00000X
FLOS10592207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology