Provider Demographics
NPI:1043236755
Name:GOMERINGER, DAVID JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:GOMERINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13691 METRO PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4321
Mailing Address - Country:US
Mailing Address - Phone:239-768-5544
Mailing Address - Fax:239-768-9607
Practice Address - Street 1:13691 METRO PKWY STE 240
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4321
Practice Address - Country:US
Practice Address - Phone:239-768-5544
Practice Address - Fax:239-768-9607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOSOOO4665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82705Medicare ID - Type Unspecified
FLE32291Medicare UPIN