MEDICARE: DR. ROGER JOHN GSTALDER MD

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	207W00000X	Ophthalmology Physician	ME 17041	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	:	1891790366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER JOHN GSTALDER MD

Provider Business Mailing Address
First Line	:	2031 LITTLE ROAD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-1294
Country	:	US
Telephone Number	:	727-375-0300
Fax Number	:	727-375-1240

Provider Business Practice Location Address
First Line	:	601 S BELCHER RD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-6301
Country	:	US
Telephone Number	:	727-799-3772
Fax Number	:	727-797-2957

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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