=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043390651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSE A GAUDIER MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 03/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1805 SE 16TH AVE SUITE 1202
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-4670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-732-8630
-----------------------------------------------------
Fax | 352-867-7895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5277
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34478-5277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-732-7095
-----------------------------------------------------
Fax | 352-867-7895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL OFFICER
-----------------------------------------------------
Name | MARIA E ALEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-732-8630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | ME0060291
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------