Provider Demographics
NPI:1659565117
Name:ROBERT M GAYNOR DPM PA
Entity Type:Organization
Organization Name:ROBERT M GAYNOR DPM PA
Other - Org Name:FOOTCARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PODIATRIST
Authorized Official - Phone:561-641-7666
Mailing Address - Street 1:6250 LANTANA RD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6608
Mailing Address - Country:US
Mailing Address - Phone:561-641-7666
Mailing Address - Fax:561-642-1590
Practice Address - Street 1:6250 LANTANA RD
Practice Address - Street 2:SUITE 22
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-6608
Practice Address - Country:US
Practice Address - Phone:561-641-7666
Practice Address - Fax:561-642-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL213ES0131X213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4694620003Medicare NSC
FL24299Medicare PIN