Provider Demographics
NPI:1134163421
Name:GADE S RAO MD PA
Entity type:Organization
Organization Name:GADE S RAO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GADE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-248-2656
Mailing Address - Street 1:PO BOX 750
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-0750
Mailing Address - Country:US
Mailing Address - Phone:850-248-2656
Mailing Address - Fax:850-248-2658
Practice Address - Street 1:2949 HIGHWAY 77
Practice Address - Street 2:BAY MEDICAL PLAZA
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4411
Practice Address - Country:US
Practice Address - Phone:850-248-2656
Practice Address - Fax:850-248-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92029208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB03205Medicare UPIN