MEDICARE: DR. EVANGELOS P GAVATHAS PH.D.

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	2085R0205X	Radiological Physics Physician	TRP-366	FL

General Provider Information

NPI Number	:	1255682936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVANGELOS P GAVATHAS PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 266173
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-6173
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6825 SW 87TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-2502
Country	:	US
Telephone Number	:	786-466-7201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2012
Last Update Date	:	09/21/2012

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