Provider Demographics
NPI:1902827819
Name:GARY, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:GARY
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 1:435 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7847
Mailing Address - Country:US
Mailing Address - Phone:850-435-7448
Mailing Address - Fax:850-435-3156
Practice Address - Street 1:435 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7847
Practice Address - Country:US
Practice Address - Phone:850-435-7448
Practice Address - Fax:850-435-3156
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91924207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59176307OtherBCBS ALABAMA
FL271951700Medicaid
FLC863OtherMED3000
FLC005OtherWELLCARE
FL52257ZOtherBCBS FLORIDA
P00185982OtherRAILROAD MEDICARE
FLC005OtherWELLCARE
D80508Medicare UPIN