Provider Demographics
NPI:1821094327
Name:BADZINSKI, GARY LEE (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:BADZINSKI
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19011 SE OUTRIGGER LN
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-1083
Mailing Address - Country:US
Mailing Address - Phone:918-978-6977
Mailing Address - Fax:
Practice Address - Street 1:449 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4507
Practice Address - Country:US
Practice Address - Phone:850-769-8341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9663207RC0000X
NC2017-00150207RC0000X
OK3416207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100088510AMedicaid
OKP00657417Medicare PIN
B45796Medicare UPIN
OKOK401299Medicare PIN
OK100088510AMedicaid