Provider Demographics
NPI:1346329406
Name:MARC R. GERBER MD PA
Entity Type:Organization
Organization Name:MARC R. GERBER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-822-8875
Mailing Address - Street 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5718
Mailing Address - Country:US
Mailing Address - Phone:407-822-8875
Mailing Address - Fax:407-822-8814
Practice Address - Street 1:1507 S HIAWASSEE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5718
Practice Address - Country:US
Practice Address - Phone:407-822-8875
Practice Address - Fax:407-822-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8889Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER