Provider Demographics
NPI:1750312096
Name:GAITHER, FRED E (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:E
Last Name:GAITHER
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 1:2430 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4304
Mailing Address - Country:US
Mailing Address - Phone:850-763-7244
Mailing Address - Fax:850-763-0157
Practice Address - Street 1:2430 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4304
Practice Address - Country:US
Practice Address - Phone:850-763-7244
Practice Address - Fax:850-763-0157
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2793213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480027828OtherMEDICARE RAILROAD
FL300456200Medicaid
FL4020320001Medicare NSC