Provider Demographics
NPI:1316903768
Name:GERSHMAN, ERIC A (M D)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:GERSHMAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:61 MEMORIAL MEDICAL PKWY STE 2812
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5999
Practice Address - Country:US
Practice Address - Phone:386-586-1860
Practice Address - Fax:386-586-1861
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55276207RH0000X, 207RX0202X
ORMD202391207RH0000X
NV17168207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124310100Medicaid
FL08985RMedicare PIN
FL08985SMedicare PIN
E65215Medicare UPIN
FL08985RMedicare PIN
FLP1001222OtherFREEDOM
FL08985SMedicare PIN
FL08985OtherBCBS
FL574698OtherWELLCARE
FLP01463489OtherRR MEDICARE
FL272118000Medicaid
FL4658485OtherAETNA
E65215Medicare UPIN