Provider Demographics
NPI:1205864105
Name:GAYNOR, ROBERT M (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:GAYNOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 LANTANA RD
Mailing Address - Street 2:22
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6608
Mailing Address - Country:US
Mailing Address - Phone:561-641-7666
Mailing Address - Fax:561-642-1590
Practice Address - Street 1:6250 LANTANA RD
Practice Address - Street 2:SUITE 22
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6608
Practice Address - Country:US
Practice Address - Phone:561-641-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1985213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029761500Medicaid
65075OtherBLUE CROSS BLUE SHIELD
FL480008476OtherRAILROAD MEDICARE
FL480008476OtherRAILROAD MEDICARE
U08355Medicare UPIN