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NPI Code Detail

MEDICARE: DR. GARY DESINORD

MEDICARE: DR. GARY DESINORD
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
1213ES0103XFoot & Ankle Surgery PodiatristPO4125FL
2213E00000XPodiatristPO4125FL
3390200000XStudent in an Organized Health Care Education/Training Program

Other Identifiers

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

General Provider Information

NPI Number : 1598299273
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY DESINORD
Provider Business Mailing Address
First Line : 1324 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4543
Country : US
Telephone Number : 863-687-1100
Fax Number :
Provider Business Practice Location Address
First Line : 2400 KATHLEEN RD
Second Line :
City : LAKELAND
State : FL
Zip : 33810-3077
Country : US
Telephone Number : 863-687-1466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2017
Last Update Date : 02/11/2026

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