Provider Demographics
NPI:1205883691
Name:GAYNOR, ROBERT DEAN (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:GAYNOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 S OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5461
Mailing Address - Country:US
Mailing Address - Phone:407-812-8110
Mailing Address - Fax:407-812-8109
Practice Address - Street 1:2898 S OSCEOLA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5461
Practice Address - Country:US
Practice Address - Phone:407-812-8110
Practice Address - Fax:407-812-8109
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57405OtherBCBS
FL57405YMedicare PIN
FL57405OtherBCBS