Provider Demographics
NPI:1992294938
Name:GAMMARANO, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GAMMARANO
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:PO BOX 17726
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7726
Mailing Address - Country:US
Mailing Address - Phone:904-647-6238
Mailing Address - Fax:904-647-0898
Practice Address - Street 1:8825 PERIMETER PARK BLVD STE 402
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1124
Practice Address - Country:US
Practice Address - Phone:904-647-6238
Practice Address - Fax:904-647-0898
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1415792085R0204X, 208D00000X
AK2125742085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology