Healthcare Provider Details

I. General information

NPI: 1144278037
Provider Name (Legal Business Name): GARREN P. GEBHARDT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 E MICHIGAN ST STE 103
ORLANDO FL
32822-2700
US

IV. Provider business mailing address

5555 E MICHIGAN ST STE 103
ORLANDO FL
32822-2700
US

V. Phone/Fax

Practice location:
  • Phone: 321-710-4000
  • Fax: 321-878-3329
Mailing address:
  • Phone: 321-710-4000
  • Fax: 321-878-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS22680
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS22680
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS22680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: