Provider Demographics
NPI:1609808419
Name:GERNERT, JOHN O (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:O
Last Name:GERNERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:515 W STATE ROAD 434
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750
Mailing Address - Country:US
Mailing Address - Phone:407-745-1115
Mailing Address - Fax:833-775-1872
Practice Address - Street 1:515 W STATE ROAD 434
Practice Address - Street 2:SUITE 201
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750
Practice Address - Country:US
Practice Address - Phone:407-745-1115
Practice Address - Fax:833-775-1872
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME87839207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52138Medicare ID - Type Unspecified