Provider Demographics
NPI:1508307901
Name:GEADA, LUIS RENE (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:RENE
Last Name:GEADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 7TH ST S STE 510
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4736
Mailing Address - Country:US
Mailing Address - Phone:727-893-6480
Mailing Address - Fax:727-893-6481
Practice Address - Street 1:601 7TH ST S STE 510
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4736
Practice Address - Country:US
Practice Address - Phone:727-893-6480
Practice Address - Fax:727-893-6481
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME154392208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program