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General NPI Number Information
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NPI Number | 1114983020
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Entity Type | Individual
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Provider Name | STEPHEN ZISL GERVIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 2301 N UNIVERSITY DR SUITE 210
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-3617
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Country | US
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Telephone | 954-961-3365
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Fax | 954-961-5629
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Provider Business Mailing Address
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Address Line | 2301 N UNIVERSITY DRIVE SUITE 210
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City | PEMBROKE PINES
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State | FL
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Zip | 33024
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Country | US
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Telephone | 954-961-3365
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Fax | 954-961-5629
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME13977
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License Number State | FL
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