Provider Demographics
NPI:1639600802
Name:GERGES, MINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:
Last Name:GERGES
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 1:17327 PAGONIA RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6009
Mailing Address - Country:US
Mailing Address - Phone:407-905-6001
Mailing Address - Fax:407-905-6001
Practice Address - Street 1:17327 PAGONIA RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6009
Practice Address - Country:US
Practice Address - Phone:407-905-6001
Practice Address - Fax:407-905-6001
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME143755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program