Provider Demographics
NPI:1073537551
Name:PEZZULLO-BURGS, GAIL M (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:M
Last Name:PEZZULLO-BURGS
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1050 NW 15TH ST
Mailing Address - Street 2:#215A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1375
Mailing Address - Country:US
Mailing Address - Phone:561-392-7704
Mailing Address - Fax:561-392-8103
Practice Address - Street 1:1050 NW 15TH ST
Practice Address - Street 2:#215A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1375
Practice Address - Country:US
Practice Address - Phone:561-392-7704
Practice Address - Fax:561-392-8103
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0047639207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D67071Medicare UPIN