Individual
JON PAUL GAUDINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3030 W BEARSS AVE, TAMPA, FL 33618
(419) 531-2127
(419) 531-2664
Mailing address
1967 SHORE ACRES BLVD NE, SAINT PETERSBURG, FL 33703
(727) 522-6687
(727) 526-9280
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME68779
FL
208100000X
Physical Medicine & Rehabilitation Physician
ME68779
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250010136
RR MEDICARE
FL
01
—
250010137
RR MEDICARE
FL
01
—
250011108
RR MEDICARE
FL
05
—
253156900
—
FL
01
—
27430
BLUE SHIELD
FL
Enumeration date
08/29/2006
Last updated
03/10/2023
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