Healthcare Provider Details

I. General information

NPI: 1518950724
Provider Name (Legal Business Name): SCOTT M GEBHARDT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/12/2006

III. Provider practice location address

2264 DOG LEG CT
BROOKSVILLE FL
34604-1000
US

IV. Provider business mailing address

2264 DOG LEG CT
BROOKSVILLE FL
34604-1000
US

V. Phone/Fax

Practice location:
  • Phone: 352-585-2422
  • Fax:
Mailing address:
  • Phone: 352-585-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS8060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: