Healthcare Provider Details

I. General information

NPI: 1821582362
Provider Name (Legal Business Name): GREGORY FRANCIS GEUBELLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

9544 TRIVOLO PL
BOCA RATON FL
33434-5626
US

V. Phone/Fax

Practice location:
  • Phone: 505-227-0377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME157219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: