Healthcare Provider Details

I. General information

NPI: 1225129646
Provider Name (Legal Business Name): GERALD P MARSHBANKS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 RANCH LAKE BLVD STE 200
BRADENTON FL
34202-3719
US

IV. Provider business mailing address

5860 RANCH LAKE BLVD STE 200
BRADENTON FL
34202-3719
US

V. Phone/Fax

Practice location:
  • Phone: 941-388-8997
  • Fax: 941-306-5876
Mailing address:
  • Phone: 941-388-8997
  • Fax: 941-306-5876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109170
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: