Healthcare Provider Details

I. General information

NPI: 1063733368
Provider Name (Legal Business Name): JAMES REED GAHAGAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 MOBILE HWY
PENSACOLA FL
32506-3229
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-453-3281
  • Fax: 850-453-4491
Mailing address:
  • Phone: 850-453-3281
  • Fax: 850-453-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS11894
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: