Provider Demographics
NPI:1568430965
Name:GAMAD, RJ (MD,PA)
Entity Type:Individual
Prefix:
First Name:RJ
Middle Name:
Last Name:GAMAD
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:ROGELIO
Other - Middle Name:J
Other - Last Name:GAMAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3232 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7423
Mailing Address - Country:US
Mailing Address - Phone:850-769-1533
Mailing Address - Fax:850-785-1189
Practice Address - Street 1:3232 E 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7423
Practice Address - Country:US
Practice Address - Phone:850-769-1533
Practice Address - Fax:850-785-1189
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0021270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055380800Medicaid
FLD50734Medicare UPIN
FL03099Medicare ID - Type Unspecified