Healthcare Provider Details

I. General information

NPI: 1588641120
Provider Name (Legal Business Name): GERALD EDWIN TOWNSEND JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2005
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 ORANGE AVE E
TALLAHASSEE FL
32311-6144
US

IV. Provider business mailing address

2181 ORANGE AVE E
TALLAHASSEE FL
32311-6144
US

V. Phone/Fax

Practice location:
  • Phone: 850-513-7521
  • Fax: 850-913-8000
Mailing address:
  • Phone: 850-513-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0058357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: