Provider Demographics
NPI:1245240829
Name:GAMEZ, GERARDO A (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:A
Last Name:GAMEZ
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 1:12670 WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3619
Mailing Address - Country:US
Mailing Address - Phone:239-936-3554
Mailing Address - Fax:239-936-8993
Practice Address - Street 1:12670 WHITEHALL DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3619
Practice Address - Country:US
Practice Address - Phone:239-936-3554
Practice Address - Fax:239-936-8993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00542952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274890800Medicaid
FLK1692Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL274890800Medicaid
FLE22511Medicare UPIN
FL08503YMedicare ID - Type UnspecifiedMEDICARE PROVIDER
P00393216Medicare PIN