MEDICARE: OB GYN OF GREATER ORLANDO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215164363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OB GYN OF GREATER ORLANDO LLC

Provider Business Mailing Address
First Line	:	5308 S JOHN YOUNG PKWY STE 300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-7362
Country	:	US
Telephone Number	:	407-846-4882
Fax Number	:	407-846-0416

Provider Business Practice Location Address
First Line	:	5308 S JOHN YOUNG PKWY STE 300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-7362
Country	:	US
Telephone Number	:	407-846-4882
Fax Number	:	407-355-3383

Authorized Official
Title or Position	:	PARTNER/PHYSICIAN
Name	:	GEROME ALEX CLEEFORD BELIARD
Credential	:	MD
Telephone Number	:	407-846-4882

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	08/16/2022

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Directions to “OB GYN OF GREATER ORLANDO LLC ” Practice Location

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