Healthcare Provider Details

I. General information

NPI: 1720074487
Provider Name (Legal Business Name): MAXIME G GEDEON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 NORTH BLVD W STE A
DAVENPORT FL
33837-8988
US

IV. Provider business mailing address

3501 BESSIE COLEMAN BLVD UNIT 25201
TAMPA FL
33622-9130
US

V. Phone/Fax

Practice location:
  • Phone: 813-701-5804
  • Fax: 813-291-7615
Mailing address:
  • Phone: 813-701-5804
  • Fax: 813-291-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD059432L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME166986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: