Provider Demographics
NPI:1710971056
Name:CHESSMAN, GARY W (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:CHESSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7560 RED BUG LAKE ROAD
Mailing Address - Street 2:SUITE 2024
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6504
Mailing Address - Country:US
Mailing Address - Phone:407-679-7444
Mailing Address - Fax:407-359-6840
Practice Address - Street 1:7560 RED BUG LAKE ROAD
Practice Address - Street 2:SUITE 2024
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6504
Practice Address - Country:US
Practice Address - Phone:407-679-7444
Practice Address - Fax:407-359-6840
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002365213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL625224OtherAETNA
FL65313OtherBCBS
FL390147500Medicaid
FL390171800Medicaid
FL65313XMedicare PIN
FL65313OtherBCBS
FL390147500Medicaid
FL390171800Medicaid