Healthcare Provider Details

I. General information

NPI: 1689776478
Provider Name (Legal Business Name): GARY STEPHEN GOSSMAN MPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 W UNIVERSITY AVE
GAINESVILLE FL
32607-7609
US

IV. Provider business mailing address

7540 W UNIVERSITY AVE
GAINESVILLE FL
32607-7609
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0335
  • Fax: 352-265-0336
Mailing address:
  • Phone: 352-265-0335
  • Fax: 352-265-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: