Provider Demographics
NPI:1033525027
Name:CHILES, GERALD DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:DOUGLAS
Last Name:CHILES
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GERALD
Other - Middle Name:DOUGLAS
Other - Last Name:CHILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4502 LANDING DR
Mailing Address - Street 2:APARTMENT E
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1394
Mailing Address - Country:US
Mailing Address - Phone:321-217-8116
Mailing Address - Fax:
Practice Address - Street 1:1950 LEE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1859
Practice Address - Country:US
Practice Address - Phone:407-960-7373
Practice Address - Fax:407-960-7375
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator