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General NPI Number Information
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NPI Number | 1639288137
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Entity Type | Individual
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Provider Name | JON PAUL GAUDINO MD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 3030 W BEARSS AVE
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City | TAMPA
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State | FL
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Zip | 33618
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Country | US
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Telephone | 419-531-2127
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Fax | 419-531-2664
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Provider Business Mailing Address
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Address Line | 1967 SHORE ACRES BLVD NE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33703
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Country | US
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Telephone | 727-522-6687
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Fax | 727-526-9280
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME68779
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME68779
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License Number State | FL
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