Provider Demographics
NPI:1619966769
Name:GAUTA, JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:GAUTA
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 1:1890 SW HEALTH PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0473
Mailing Address - Country:US
Mailing Address - Phone:239-592-1388
Mailing Address - Fax:239-593-3356
Practice Address - Street 1:1890 SW HEALTH PKWY
Practice Address - Street 2:STE 205
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0473
Practice Address - Country:US
Practice Address - Phone:239-592-1388
Practice Address - Fax:239-593-3356
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074608207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254515200Medicaid
FL46457OtherBCBS
FL46457OtherBCBS
FLE0762YMedicare ID - Type Unspecified