Provider Demographics
NPI:1891790366
Name:GSTALDER, ROGER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JOHN
Last Name:GSTALDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2031 LITTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1294
Mailing Address - Country:US
Mailing Address - Phone:727-375-0300
Mailing Address - Fax:727-375-1240
Practice Address - Street 1:601 S BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6301
Practice Address - Country:US
Practice Address - Phone:727-799-3772
Practice Address - Fax:727-797-2957
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 17041207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255271000Medicaid
FL29685YMedicare ID - Type Unspecified
FL255271000Medicaid