Provider Demographics
NPI:1922091065
Name:GERSON, JEFFREY
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 S BAYSHORE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COCONUT GROVE
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5309
Mailing Address - Country:US
Mailing Address - Phone:305-859-2256
Mailing Address - Fax:305-859-2680
Practice Address - Street 1:2701 S BAYSHORE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-5309
Practice Address - Country:US
Practice Address - Phone:305-859-2256
Practice Address - Fax:305-859-2680
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00427142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63885Medicare UPIN
FL96519Medicare ID - Type Unspecified