MEDICARE: MR. RENATO C. GAHOL M.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	2084P0800X	Psychiatry Physician	054097	GA
2	2084P0800X	Psychiatry Physician	M-1410	GU

General Provider Information

NPI Number	:	1508862269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RENATO C. GAHOL M.D.

Provider Business Mailing Address
First Line	:	790 GOV. CARLOS G. CAMACHO RD.
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-647-5413
Fax Number	:	671-649-6948

Provider Business Practice Location Address
First Line	:	790 GOV. CARLOS G. CAMACHO RD.
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-647-5413
Fax Number	:	671-649-6948

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/24/2013

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