Provider Demographics
NPI:1730351362
Name:GERALD R GOSS D.O., P.A.
Entity type:Organization
Organization Name:GERALD R GOSS D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-277-7671
Mailing Address - Street 1:1713 FOXBOWER RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6506
Mailing Address - Country:US
Mailing Address - Phone:407-277-7671
Mailing Address - Fax:407-277-7326
Practice Address - Street 1:1713 FOXBOWER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6506
Practice Address - Country:US
Practice Address - Phone:407-277-7671
Practice Address - Fax:407-277-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0001386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81231OtherBLUE CROSS BLUE SHIELD FL
FL10829OtherFL HOSP HEALTHCARE SYSTEM
FL046391400Medicaid
GA014743136OtherPALMETTO GBA RR MCR
FLK1207Medicare PIN
FL81231OtherBLUE CROSS BLUE SHIELD FL