Provider Demographics
NPI:1467436097
Name:LIONEL J GATIEN DO PA
Entity Type:Organization
Organization Name:LIONEL J GATIEN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GATIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-269-1366
Mailing Address - Street 1:1689 EAGLE HARBOR PKWY E
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4817
Mailing Address - Country:US
Mailing Address - Phone:904-269-1366
Mailing Address - Fax:904-264-9750
Practice Address - Street 1:1689 EAGLE HARBOR PKWY E
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-4817
Practice Address - Country:US
Practice Address - Phone:904-269-1366
Practice Address - Fax:904-264-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255795900Medicaid
FL21990Medicare ID - Type Unspecified