Provider Demographics
NPI:1982861340
Name:GYANG, ANTHONY NYARKO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:NYARKO
Last Name:GYANG
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 1:3004 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6011
Mailing Address - Country:US
Mailing Address - Phone:407-556-3973
Mailing Address - Fax:321-805-4718
Practice Address - Street 1:3004 17TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6011
Practice Address - Country:US
Practice Address - Phone:407-556-3973
Practice Address - Fax:321-805-4718
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110498207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003706400Medicaid
FLFE860ZMedicare UPIN