Provider Demographics
NPI:1689776478
Name:GOSSMAN, GARY STEPHEN (MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:STEPHEN
Last Name:GOSSMAN
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7540 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7609
Mailing Address - Country:US
Mailing Address - Phone:352-265-0335
Mailing Address - Fax:352-265-0336
Practice Address - Street 1:7540 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-7609
Practice Address - Country:US
Practice Address - Phone:352-265-0335
Practice Address - Fax:352-265-0336
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0000678OtherFLORIDA PRESCRIBING #
FLY05RROtherFLORIDA BLUE PROVIDER ID
FL290070000Medicaid
FLP01778Medicare UPIN
FLE3796ZMedicare ID - Type Unspecified
FLE3796VMedicare PIN