Provider Demographics
NPI:1497750038
Name:GAMA, CARLOS H (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:H
Last Name:GAMA
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:PO BOX 44004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4004
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-636-5786
Practice Address - Street 1:2736 UNIVERSITY BLVD W STE 3
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2170
Practice Address - Country:US
Practice Address - Phone:904-733-4262
Practice Address - Fax:904-636-5786
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-11-18
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
FLME394922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0450456-00Medicaid
FL0450456-00Medicaid
FLC67313Medicare UPIN
FLC67313Medicare UPIN