Provider Demographics
NPI:1326403585
Name:GENTLE CARE PODIATRY, LLC
Entity Type:Organization
Organization Name:GENTLE CARE PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RAMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-738-7381
Mailing Address - Street 1:8450 GATE PKWY W
Mailing Address - Street 2:UNIT 1504
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1049
Mailing Address - Country:US
Mailing Address - Phone:904-738-7381
Mailing Address - Fax:904-738-7259
Practice Address - Street 1:8450 GATE PKWY W
Practice Address - Street 2:UNIT 1504
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1049
Practice Address - Country:US
Practice Address - Phone:904-738-7381
Practice Address - Fax:904-738-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3446213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002849500Medicaid