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NPI Code Detail

MEDICARE: MARY JEAN GOSSMAN MPAS, PA-C

MEDICARE:   MARY JEAN GOSSMAN  MPAS, PA-C
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
1363A00000XPhysician AssistantPA1809FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100000340OTHERFLFLORIDA PRESCRIBING #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3PA1809OTHERFLFL LICENSE #

General Provider Information

NPI Number : 1225083082
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JEAN GOSSMAN MPAS, PA-C
Provider Business Mailing Address
First Line : 18808 NW 72ND AVE
Second Line :
City : ALACHUA
State : FL
Zip : 32615-7599
Country : US
Telephone Number : 386-418-0111
Fax Number :
Provider Business Practice Location Address
First Line : 105 NW SANTA FE BLVD
Second Line : HIGH SPRINGS MEDICAL CENTER
City : HIGH SPRINGS
State : FL
Zip : 32655
Country : US
Telephone Number : 386-454-7746
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 06/12/2012

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Directions to “ MARY JEAN GOSSMAN MPAS, PA-C” Practice Location

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