| Entity Name: | R.J. GAMAD M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 25 Oct 1978 (46 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | 591035 |
| FEI/EIN Number | 59-1853285 |
| Address: | 100 ARRICOLA AVE, ST AUGUSTINE, FL 32080 |
| Mail Address: | 100 ARRICOLA AVE, ST AUGUSTINE, FL 32080 |
| ZIP code: | 32080 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588976252 | 2010-07-09 | 2014-10-28 | 3232 E 15TH ST, PANAMA CITY, FL, 324057423, US | 3232 E 15TH ST, PANAMA CITY, FL, 324057423, US | |||||||||||||||||||||||||
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| Phone | +1 850-769-1533 |
| Fax | 8507851189 |
Authorized person
| Name | ROGELIO JINCO GAMAD |
| Role | PHYSICIAN |
| Phone | 8507691533 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME0021270 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 055380800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CULVER, DAVE | Agent | 100 ARRICOLA AVE, ST AUGUSTINE, FL 32080 |
| Name | Role | Address |
|---|---|---|
| HINMAN II, ROY H, MD | President | 100 ARRICOLA AVE, ST AUGUSTINE, FL 32080 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| AMENDMENT | 2019-01-04 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-01-04 | 100 ARRICOLA AVE, ST AUGUSTINE, FL 32080 | No data |
| CHANGE OF MAILING ADDRESS | 2019-01-04 | 100 ARRICOLA AVE, ST AUGUSTINE, FL 32080 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-01-04 | CULVER, DAVE | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2000-08-08 | 100 ARRICOLA AVE, ST AUGUSTINE, FL 32080 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000863657 | TERMINATED | 1000000307476 | BAY | 2012-10-30 | 2032-11-28 | $ 660.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, PANAMA CITY SERVICE CENTER, 210 N TYNDALL PKWY, PANAMA CITY FL324046432 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-04-30 |
| Amendment | 2019-01-04 |
| ANNUAL REPORT | 2018-02-13 |
| ANNUAL REPORT | 2017-02-15 |
| ANNUAL REPORT | 2016-03-10 |
| ANNUAL REPORT | 2015-04-07 |
| ANNUAL REPORT | 2014-04-29 |
| ANNUAL REPORT | 2013-05-02 |
| ANNUAL REPORT | 2012-03-06 |
| ANNUAL REPORT | 2011-01-28 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
