Provider Demographics
NPI:1295726933
Name:GONTER, PAUL W (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:GONTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN: CREDENTIAL DEPARTMENT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:836 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7554
Practice Address - Country:US
Practice Address - Phone:941-408-0500
Practice Address - Fax:941-496-8558
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-05-03
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Provider Licenses
StateLicense IDTaxonomies
FLME85932207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252556900Medicaid
FL252556900Medicaid
FL252556900Medicaid
FL58468YMedicare PIN
FLD93228Medicare UPIN