Healthcare Provider Details

I. General information

NPI: 1699716019
Provider Name (Legal Business Name): CHRISTOPHER A GEGG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3050
  • Fax: 321-841-3049
Mailing address:
  • Phone: 321-841-3050
  • Fax: 321-841-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME 0080966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: