Provider Demographics
NPI:1649895822
Name:FRED E GATIHER II DPM
Entity type:Organization
Organization Name:FRED E GATIHER II DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAITHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:850-763-7244
Mailing Address - Street 1:2430 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4304
Mailing Address - Country:US
Mailing Address - Phone:850-763-7244
Mailing Address - Fax:850-763-7244
Practice Address - Street 1:2 MIRACLE STRIP LOOP STE 3
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-8412
Practice Address - Country:US
Practice Address - Phone:850-763-7244
Practice Address - Fax:850-763-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65627OtherBLUE CROSS & BLUE SHIELD
FL578NKOtherBLUE CROSS BLUE SHIELD