Basic Information
Provider Information
NPI: 1356306112
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GEBHARD
FirstName: RALF
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1611 NW 12TH AVE
Address2: BOX 016960 M851
City: MIAMI
State: FL
PostalCode: 331361005
CountryCode: US
TelephoneNumber: 3052436358
FaxNumber: 3052438470
Practice Location
Address1: 1611 NW 12TH AVE
Address2: BOX 016960 M851
City: MIAMI
State: FL
PostalCode: 331361005
CountryCode: US
TelephoneNumber: 3052436358
FaxNumber: 3052438470
Other Information
ProviderEnumerationDate: 04/17/2006
LastUpdateDate: 04/23/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XME100309FLY Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000XMFC1588FLN Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home