Provider Demographics
NPI:1003042854
Name:ERDAG, GULSUN (MD)
Entity Type:Individual
Prefix:
First Name:GULSUN
Middle Name:
Last Name:ERDAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GULSUN
Other - Middle Name:
Other - Last Name:EROGLU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 SW ARCHER RD BOX 100275
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0001
Mailing Address - Country:US
Mailing Address - Phone:352-265-9900
Mailing Address - Fax:352-265-9901
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0010
Practice Address - Country:US
Practice Address - Phone:352-265-9900
Practice Address - Fax:352-265-9901
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136909207ZC0500X, 207ZD0900X, 207ZP0102X
MDD72968207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105714700Medicaid
MD227121ZAH4Medicare PIN