Healthcare Provider Details

I. General information

NPI: 1619269727
Provider Name (Legal Business Name): VICTORIA M GAUS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2011
Last Update Date: 05/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9877 PINES BLVD
PEMBROKE PINES FL
33024-6164
US

IV. Provider business mailing address

9877 PINES BLVD
PEMBROKE PINES FL
33024-6164
US

V. Phone/Fax

Practice location:
  • Phone: 954-431-8022
  • Fax: 954-431-8078
Mailing address:
  • Phone: 954-431-8022
  • Fax: 954-431-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA M GAUS
Title or Position: OWNER
Credential: M.D.
Phone: 954-431-8022