Provider Demographics
NPI:1629230362
Name:GERLEY, PETER PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:PAUL
Last Name:GERLEY
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:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4202 E FOWLER AVE
Practice Address - Street 2:SHS 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33620-9951
Practice Address - Country:US
Practice Address - Phone:813-974-2331
Practice Address - Fax:813-974-7181
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29631207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53716OtherBLUE CROSS BLUE SHIELD
FL000200000Medicaid
FL53716YMedicare PIN