Healthcare Provider Details

I. General information

NPI: 1245349828
Provider Name (Legal Business Name): JORGE L GAUD MORALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/28/2024
Certification Date: 08/10/2023
Deactivation Date: 10/03/2024
Reactivation Date: 10/28/2024

III. Provider practice location address

5350 SPRING HILL DR
SPRING HILL FL
34606-4562
US

IV. Provider business mailing address

5400 PINEHURST DR
SPRING HILL FL
34606-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-8116
  • Fax: 352-686-9477
Mailing address:
  • Phone: 352-277-5305
  • Fax: 352-616-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: