Healthcare Provider Details

I. General information

NPI: 1619085503
Provider Name (Legal Business Name): MOISES GELRUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST RM 1113D49
MIAMI FL
33136
US

IV. Provider business mailing address

1120 NW 14TH ST RM 1113D49
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-8040
  • Fax: 305-243-3762
Mailing address:
  • Phone: 305-243-8040
  • Fax: 305-243-3762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number214783
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: