Provider Demographics
NPI:1043524176
Name:MATHUR, GAURAV (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:
Last Name:MATHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10065 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6389
Mailing Address - Country:US
Mailing Address - Phone:352-596-4660
Mailing Address - Fax:352-596-4674
Practice Address - Street 1:10065 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34613-6389
Practice Address - Country:US
Practice Address - Phone:352-596-4660
Practice Address - Fax:352-596-4674
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444064207R00000X
FLME121449207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14YM0OtherBCBS
FL013916600Medicaid
FLP01483698OtherRR MCR
FLHZ078ZMedicare PIN
FLP01483698OtherRR MCR
FL013916600Medicaid