Provider Demographics
NPI:1659419992
Name:GERSHON, JULIAN R (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:R
Last Name:GERSHON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 HANCOCK BR PKWY
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7094
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:2400 S MCCALL RD
Practice Address - Street 2:SUITE C
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-5137
Practice Address - Country:US
Practice Address - Phone:941-474-9314
Practice Address - Fax:941-473-9813
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS1928208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80291OtherBLUE CROSS
FL80291OtherBLUE CROSS
FL80291VMedicare PIN
FLE26062Medicare UPIN