Provider Demographics
NPI:1205864105
Name:GAYNOR, ROBERT M (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:GAYNOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 FAIRLANE FARMS RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6503
Mailing Address - Country:US
Mailing Address - Phone:877-405-3668
Mailing Address - Fax:561-721-7070
Practice Address - Street 1:3281 FAIRLANE FARMS RD STE 4
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6503
Practice Address - Country:US
Practice Address - Phone:877-405-3668
Practice Address - Fax:561-721-7070
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1985213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480008476OtherRAILROAD MEDICARE
65075OtherBLUE CROSS BLUE SHIELD
FL029761501Medicaid
FL480008476OtherRAILROAD MEDICARE
U08355Medicare UPIN