Individual
GAUTAM GANGULY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3775 N LECANTO HWY, BEVERLY HILLS, FL 34465-3559
(352) 746-0600
(352) 746-0607
Mailing address
PO BOX 640573, STE 146, BEVERLY HILLS, FL 34464-0573
(352) 746-0600
(352) 746-0607
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
019167
PR
208D00000X
General Practice Physician
Primary
ACN1448
FL
Other
Enumeration date
08/24/2015
Last updated
09/12/2025
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