Healthcare Provider Details

I. General information

NPI: 1316264435
Provider Name (Legal Business Name): BRIAN L GADBOIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W LINEBAUGH AVE
TAMPA FL
33612
US

IV. Provider business mailing address

825 W LINEBAUGH AVE
TAMPA FL
33612
US

V. Phone/Fax

Practice location:
  • Phone: 813-931-5560
  • Fax: 813-932-4960
Mailing address:
  • Phone: 813-931-5560
  • Fax: 813-932-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME112401
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME112401
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME112401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: