Provider Demographics
NPI:1174544720
Name:ARTHUR, GARY KENNETH (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:KENNETH
Last Name:ARTHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 WEST DR MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603
Mailing Address - Country:US
Mailing Address - Phone:813-221-8122
Mailing Address - Fax:813-221-8031
Practice Address - Street 1:722 WEST DR MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603
Practice Address - Country:US
Practice Address - Phone:813-221-8122
Practice Address - Fax:813-221-8031
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00214402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
53765Medicare UPIN
29857Medicare ID - Type Unspecified