Provider Demographics
NPI:1700804507
Name:GESSNER, IRA H (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:H
Last Name:GESSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IRA
Other - Middle Name:H
Other - Last Name:GESSNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-6431
Practice Address - Fax:352-392-6771
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97562080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040140400Medicaid
FLD83983Medicare UPIN
01706YMedicare PIN