Provider Demographics
NPI:1275553174
Name:SISON, GERARDO POSADAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:POSADAS
Last Name:SISON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:34650 U.S. HWY 19 N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2155
Mailing Address - Country:US
Mailing Address - Phone:727-787-3422
Mailing Address - Fax:727-787-5624
Practice Address - Street 1:34650 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 107
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2155
Practice Address - Country:US
Practice Address - Phone:727-787-3422
Practice Address - Fax:727-787-5624
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME537252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064334300Medicaid
FL064334300Medicaid