Provider Demographics
NPI:1043390651
Name:JOSE A GAUDIER MD PA
Entity Type:Organization
Organization Name:JOSE A GAUDIER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-732-8630
Mailing Address - Street 1:PO BOX 5277
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-5277
Mailing Address - Country:US
Mailing Address - Phone:352-732-7095
Mailing Address - Fax:352-867-7895
Practice Address - Street 1:1805 SE 16TH AVE
Practice Address - Street 2:SUITE 1202
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4670
Practice Address - Country:US
Practice Address - Phone:352-732-8630
Practice Address - Fax:352-867-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00602912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12485OtherBLUE CROSS
FL7218232004OtherCIGNA
FL055513400Medicaid
FL214728OtherAVMED
FL22593OtherWELLCARE
FLDF6521OtherRR MEDICARE
FLDF6521OtherRR MEDICARE
FL12485OtherBLUE CROSS
FL055513400Medicaid