Provider Demographics
NPI:1962698647
Name:SANCHEZ, GERVASIO (MD)
Entity type:Individual
Prefix:DR
First Name:GERVASIO
Middle Name:
Last Name:SANCHEZ
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 1:1840 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-6063
Mailing Address - Country:US
Mailing Address - Phone:561-964-1181
Mailing Address - Fax:561-964-1196
Practice Address - Street 1:1840 FOREST HILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-6063
Practice Address - Country:US
Practice Address - Phone:561-964-1181
Practice Address - Fax:561-964-1196
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME108898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003212900Medicaid