Provider Demographics
NPI:1538532759
Name:GAGNE, ARTHUR (CPO)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:GAGNE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12851 FORT KING RD
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5608
Mailing Address - Country:US
Mailing Address - Phone:352-437-3979
Mailing Address - Fax:352-437-3980
Practice Address - Street 1:12851 FORT KING RD
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5608
Practice Address - Country:US
Practice Address - Phone:352-437-3979
Practice Address - Fax:352-437-3980
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCPO0-27921744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management