Basic Information
| Provider Information | |||||||||
| NPI: | 1467436097 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIONEL J GATIEN DO PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1689 EAGLE HARBOR PKWY E | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320034817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042691366 | ||||||||
| FaxNumber: | 9042649750 | ||||||||
| Practice Location | |||||||||
| Address1: | 1689 EAGLE HARBOR PKWY E | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320034817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042691366 | ||||||||
| FaxNumber: | 9042649750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | GATIEN | ||||||||
| AuthorizedOfficialFirstName: | LIONEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9042691366 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 255795900 | 05 | FL | MEDICAID |