Provider Demographics
NPI:1639288137
Name:GAUDINO, JON PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:PAUL
Last Name:GAUDINO
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 1:1967 SHORE ACRES BLVD NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703
Mailing Address - Country:US
Mailing Address - Phone:727-522-6687
Mailing Address - Fax:727-526-9280
Practice Address - Street 1:3030 W BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:419-531-2127
Practice Address - Fax:419-531-2664
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68779208100000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250010137OtherRR MEDICARE
FL250011108OtherRR MEDICARE
FL253156900Medicaid
FL27430OtherBLUE SHIELD
FL250010136OtherRR MEDICARE
FL250010136OtherRR MEDICARE
FL250010137OtherRR MEDICARE
FL253156900Medicaid
FL250011108OtherRR MEDICARE
FL27430QMedicare ID - Type Unspecified