Healthcare Provider Details

I. General information

NPI: 1649475583
Provider Name (Legal Business Name): DAVID JESSE GERTH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 05/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST CRB 4TH FL
MIAMI FL
33136-2107
US

IV. Provider business mailing address

300 S BISCAYNE BLVD APT 3211
MIAMI FL
33131-5312
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4500
  • Fax:
Mailing address:
  • Phone: 901-283-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MA09108500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME117335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: