1912090978 NPI number — GERARD J. FISCHER JR. P.A.

Table of content: JORGE GONZALEZ-CRUZ MD (NPI 1386850006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912090978 NPI number — GERARD J. FISCHER JR. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISCHER
Provider First Name:
GERARD
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912090978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26067
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84126-0067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-624-0400
Provider Business Mailing Address Fax Number:
239-624-0401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 7TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102-5754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-624-0310
Provider Business Practice Location Address Fax Number:
239-624-0311
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA2582 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112864100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y01E3 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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