Healthcare Provider Details

I. General information

NPI: 1326392614
Provider Name (Legal Business Name): LAUREN GEBHARD R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SE 3RD AVE SUITE 415
FORT LAUDERDALE FL
33316-2521
US

IV. Provider business mailing address

204 SHELTER CV
WOODSTOCK GA
30189-5127
US

V. Phone/Fax

Practice location:
  • Phone: 954-713-3126
  • Fax:
Mailing address:
  • Phone: 770-656-9771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: