Individual
MR. GARY WAYNE CATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
400 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5784
(904) 819-4478
Mailing address
PO BOX 44008, PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
(904) 819-4478
(904) 244-3425
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
OS4397
FL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
OS4397
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276220000
—
FL
Enumeration date
02/21/2007
Last updated
11/01/2011
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