Provider Demographics
NPI:1588987747
Name:GERARD M. GERLING M.D., P.A.
Entity type:Organization
Organization Name:GERARD M. GERLING M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GERLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-825-1114
Mailing Address - Street 1:300 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 4002
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3707
Mailing Address - Country:US
Mailing Address - Phone:904-825-1114
Mailing Address - Fax:904-829-1546
Practice Address - Street 1:300 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 4002
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3707
Practice Address - Country:US
Practice Address - Phone:904-825-1114
Practice Address - Fax:904-829-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME280112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038069500Medicaid
FLD21503Medicare UPIN