MEDICARE: DR. PAUL W. GONTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0000X	Hematology (Internal Medicine) Physician	ME85932	FL
2	207RX0202X	Medical Oncology Physician	ME85932	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295726933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL W. GONTER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:	ATTN: CREDENTIAL DEPARTMENT
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:	239-278-3350

Provider Business Practice Location Address
First Line	:	836 SUNSET LAKE BLVD
Second Line	:	SUITE 101
City	:	VENICE
State	:	FL
Zip	:	34292-7554
Country	:	US
Telephone Number	:	941-408-0500
Fax Number	:	941-496-8558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/03/2022

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