MEDICARE: GADE S RAO MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME92029	FL

General Provider Information

NPI Number	:	1134163421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GADE S RAO MD PA

Provider Business Mailing Address
First Line	:	PO BOX 750
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-0750
Country	:	US
Telephone Number	:	850-248-2656
Fax Number	:	850-248-2658

Provider Business Practice Location Address
First Line	:	2949 HIGHWAY 77
Second Line	:	BAY MEDICAL PLAZA
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4411
Country	:	US
Telephone Number	:	850-248-2656
Fax Number	:	850-248-2658

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GADE S RAO
Credential	:	M.D.
Telephone Number	:	850-248-2656

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/22/2020

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