MEDICARE: DR. GARRETT B GAUSE I 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	207Q00000X	Family Medicine Physician	ME84560	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME84560	OTHER	FL	FL STATE LICENSE

General Provider Information

NPI Number	:	1538110028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRETT B GAUSE I M.D.

Provider Business Mailing Address
First Line	:	1722 MARINER WAY
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-5853
Country	:	US
Telephone Number	:	727-942-2213
Fax Number	:

Provider Business Practice Location Address
First Line	:	4830 W KENNEDY BLVD
Second Line	:	STE 440
City	:	TAMPA
State	:	FL
Zip	:	33609-2564
Country	:	US
Telephone Number	:	813-286-8100
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	03/07/2023

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