Provider Demographics
NPI:1881678753
Name:STERNBERG, EREZ GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EREZ
Middle Name:GABRIEL
Last Name:STERNBERG
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 1:7711 BAYMEADOWS RD E
Mailing Address - Street 2:SUITE #6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9675
Mailing Address - Country:US
Mailing Address - Phone:904-638-5555
Mailing Address - Fax:
Practice Address - Street 1:7711 BAYMEADOWS RD E
Practice Address - Street 2:SUITE #6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9675
Practice Address - Country:US
Practice Address - Phone:904-638-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88836208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106720AMedicaid
FL003305900Medicaid
GA003106720AMedicaid