Provider Demographics
NPI:1194909531
Name:BUDD, GERARD JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JOSEPH
Last Name:BUDD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:880 A1A N STE 16
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3228
Mailing Address - Country:US
Mailing Address - Phone:904-280-1300
Mailing Address - Fax:904-280-1220
Practice Address - Street 1:880 A1A N STE 16
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3228
Practice Address - Country:US
Practice Address - Phone:904-280-1300
Practice Address - Fax:904-280-1220
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044413207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61843Medicare UPIN