Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0116025236 | VA |
Y | 207Q00000X | Family Doctor | OS12953 | FL |
NPI | 1003171901 |
---|---|
Provider Name | Dr. Gavin Charles Whapshare |
First Address | Venice, FL 34292-3190 |
Second Address | Venice, FL 34292-3190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2012 |
Last Update Date | 14/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OS12953 | STATE LICENSE (01) | FL |