Provider Demographics
NPI:1003171901
Name:WHAPSHARE, GAVIN CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:CHARLES
Last Name:WHAPSHARE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1720 E VENICE AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3190
Mailing Address - Country:US
Mailing Address - Phone:941-483-9700
Mailing Address - Fax:941-483-9715
Practice Address - Street 1:1720 E VENICE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3190
Practice Address - Country:US
Practice Address - Phone:941-483-9700
Practice Address - Fax:941-483-9715
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0116025236207Q00000X
FLOS12953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS12953OtherSTATE LICENSE