Provider Demographics
NPI:1730701731
Name:GAUGER, WALTER WILLIAM
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:WILLIAM
Last Name:GAUGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21560 BACCARAT LN UNIT 201
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-4900
Mailing Address - Country:US
Mailing Address - Phone:239-216-2352
Mailing Address - Fax:
Practice Address - Street 1:217 AIRPORT PULLING RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-3502
Practice Address - Country:US
Practice Address - Phone:866-366-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty