Provider Demographics
NPI:1124026117
Name:PEDROZA-SIERRA, GERARDO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:ANTONIO
Last Name:PEDROZA-SIERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:6090 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4401
Practice Address - Country:US
Practice Address - Phone:941-218-2353
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15516208D00000X
FLACN631261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9120272OtherHUMANA HEALTH PLAN
PR9120272OtherHUMANA INSURANCE
PR9120272OtherHUMANA GOLD CHOICE
PRI-33667Medicare UPIN
PR9120272OtherHUMANA HEALTH PLAN
PR2519OtherAMERICAN HEALTH MEDICARE
PR500551EOtherMEDICARE Y MUCHO MAS
PR9120272OtherHUMANA GOLD CHOICE
PR$$$$$$$$$OtherMCS CLASSICARE
PR$$$$$$$$$OtherMCS
PR4457OtherPMC MEDICARE CHOICE
PR0023116PEOtherTRIPLE S MEDICARE OPTIMO
PRI-33667Medicare UPIN
PR660676347OtherMAPFRE LIFE
PR9120272OtherHUMANA HEALTH PLAN