Provider Demographics
NPI:1245250505
Name:OLIVERA, GERARDO FRANCISCO (MD)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:FRANCISCO
Last Name:OLIVERA
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 1:865 SE MONTEREY COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3337
Mailing Address - Country:US
Mailing Address - Phone:772-266-4713
Mailing Address - Fax:772-888-9082
Practice Address - Street 1:865 SE MONTEREY COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3337
Practice Address - Country:US
Practice Address - Phone:772-266-4713
Practice Address - Fax:772-888-9082
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD606497612084P0800X
FLME570532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062323700Medicaid
FL062323700Medicaid
FLE96400Medicare UPIN
FL09913COtherMEDICARE
FLP00784255OtherRAILROAD MEDICARE