MEDICARE: DR. IDA JOANN GAGLIARDI 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	207Q00000X	Family Medicine Physician	ME89791	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760488464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IDA JOANN GAGLIARDI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 919771
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-9771
Country	:	US
Telephone Number	:	239-278-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 KINGS HWY
Second Line	:	SUITE 210
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33980-2917
Country	:	US
Telephone Number	:	239-344-2306
Fax Number	:	941-629-2365

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/28/2020

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