Provider Demographics
NPI:1164414090
Name:SCHWENK, GORDON C (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:C
Last Name:SCHWENK
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 1:3130 SW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4445
Mailing Address - Country:US
Mailing Address - Phone:352-622-5183
Mailing Address - Fax:352-622-2720
Practice Address - Street 1:1500 SE MAGNOLIA EXT
Practice Address - Street 2:SUITE 106
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4463
Practice Address - Country:US
Practice Address - Phone:352-622-5183
Practice Address - Fax:352-622-1348
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044089207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79859OtherBC/BS PROVIDER NUMBER
FL068681600Medicaid
FL79859OtherBC/BS PROVIDER NUMBER
D58955Medicare UPIN