Healthcare Provider Details

I. General information

NPI: 1649435363
Provider Name (Legal Business Name): GERT JACOBUS SMALBERGER MBCHB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7652 ASHLEY PARK CT STE 305
ORLANDO FL
32835-6199
US

IV. Provider business mailing address

7350 FUTURES DR STE 12A
ORLANDO FL
32819-9082
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-7333
  • Fax:
Mailing address:
  • Phone: 407-730-8980
  • Fax: 407-730-8983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME109195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: