Provider Demographics
NPI:1538110028
Name:GAUSE, GARRETT B I (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:B
Last Name:GAUSE
Suffix:I
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 1:1722 MARINER WAY
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-5853
Mailing Address - Country:US
Mailing Address - Phone:727-942-2213
Mailing Address - Fax:
Practice Address - Street 1:4830 W KENNEDY BLVD
Practice Address - Street 2:STE 440
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2564
Practice Address - Country:US
Practice Address - Phone:813-286-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME84560OtherFL STATE LICENSE
FLME84560OtherFL STATE LICENSE
FLME84560OtherFL STATE LICENSE
FLE8074ZMedicare ID - Type Unspecified