Provider Demographics
NPI:1386689867
Name:GAISER, CORY R (DO)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:R
Last Name:GAISER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1399 JENKS AVE BLDG G
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2442
Mailing Address - Country:US
Mailing Address - Phone:850-771-2001
Mailing Address - Fax:850-390-4007
Practice Address - Street 1:1399 JENKS AVE BLDG G
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-771-2001
Practice Address - Fax:850-215-4229
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2022-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7830207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58872ZMedicare ID - Type Unspecified
G90818Medicare UPIN