Healthcare Provider Details

I. General information

NPI: 1598741092
Provider Name (Legal Business Name): PEDRO L GELIGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MEDICAL PLAZA DR
LEESBURG FL
34748-7311
US

IV. Provider business mailing address

PO BOX 492330
LEESBURG FL
34749-2330
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-7611
  • Fax: 352-787-7216
Mailing address:
  • Phone: 352-787-7611
  • Fax: 352-787-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME0053315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: