Basic Information
| Provider Information | |||||||||
| NPI: | 1265442727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GWINN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13537 US HIGHWAY 1 | ||||||||
| Address2: | 132 | ||||||||
| City: | SEBASTIAN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329583760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7729180104 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 FIR ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921012327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 02/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | G24818 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | G24818 | CA | N | Allopathic & Osteopathic Physicians | General Practice | 207P00000X | ME122910 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | ME122910 | FL | N | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.