Provider Demographics
NPI:1588641120
Name:TOWNSEND, GERALD EDWIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EDWIN
Last Name:TOWNSEND
Suffix:JR
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 1:2181 ORANGE AVE E
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-6144
Mailing Address - Country:US
Mailing Address - Phone:850-513-7521
Mailing Address - Fax:
Practice Address - Street 1:2181 ORANGE AVE E
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-6144
Practice Address - Country:US
Practice Address - Phone:850-513-7521
Practice Address - Fax:850-913-8000
Is Sole Proprietor?:No
Enumeration Date:2005-12-25
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66370Medicare UPIN
FL11383Medicare ID - Type Unspecified