Provider Demographics
NPI:1700883022
Name:FELSBERG, GARY JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:JOSEPH
Last Name:FELSBERG
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 1:629A E HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3517
Mailing Address - Country:US
Mailing Address - Phone:954-698-9399
Mailing Address - Fax:954-698-6963
Practice Address - Street 1:1030 SHADOWMOSS CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4440
Practice Address - Country:US
Practice Address - Phone:407-716-5344
Practice Address - Fax:954-698-6963
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME650032085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00044851OtherRR MEDICARE
FL377608500Medicaid
FL27427OtherBCBS OF FLORIDA
FL27427TMedicare PIN
FL27427YMedicare PIN