Healthcare Provider Details

I. General information

NPI: 1932157062
Provider Name (Legal Business Name): DAVID RERKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2709
US

IV. Provider business mailing address

PO BOX 100254
GAINESVILLE FL
32610-0254
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5199
  • Fax: 352-392-6781
Mailing address:
  • Phone: 352-273-8610
  • Fax: 352-273-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME95500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: