Provider Demographics
NPI:1720074487
Name:GEDEON, MAXIME G (MD)
Entity type:Individual
Prefix:DR
First Name:MAXIME
Middle Name:G
Last Name:GEDEON
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 1:3501 BESSIE COLEMAN BLVD UNIT 25201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-9130
Mailing Address - Country:US
Mailing Address - Phone:813-701-5804
Mailing Address - Fax:813-291-7615
Practice Address - Street 1:2310 NORTH BLVD W STE A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8988
Practice Address - Country:US
Practice Address - Phone:813-701-5804
Practice Address - Fax:813-291-7615
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059432L207LP2900X
FLME166986207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875476OtherBLUE SHIELD
PA0015959640008Medicaid
PA875476OtherBLUE SHIELD
PA875476QXYMedicare ID - Type Unspecified