Provider Demographics
NPI:1790731222
Name:GAUPP, FREDERICK B (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:B
Last Name:GAUPP
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 1:10556 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4109
Mailing Address - Country:US
Mailing Address - Phone:228-539-2399
Mailing Address - Fax:228-539-2377
Practice Address - Street 1:10556 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4109
Practice Address - Country:US
Practice Address - Phone:228-539-2399
Practice Address - Fax:228-539-2377
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016195207P00000X
MS09750207P00000X
ALMD.27709207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009942867Medicaid
LA1338940Medicaid
AL051538562OtherBCBS
AL7943900OtherAETNA
AL7943900OtherAETNA
LAA73169Medicare UPIN