Healthcare Provider Details

I. General information

NPI: 1598744070
Provider Name (Legal Business Name): DAVID A. GEDULD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 NE 47TH ST 2ND FLOOR
FT LAUDERDALE FL
33308-7708
US

IV. Provider business mailing address

1960 NE 47TH ST 2ND FLOOR
FT LAUDERDALE FL
33308-7708
US

V. Phone/Fax

Practice location:
  • Phone: 954-493-5005
  • Fax: 954-938-0957
Mailing address:
  • Phone: 954-493-5005
  • Fax: 954-938-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0064605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: