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General NPI Number Information
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NPI Number | 1306837281
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Entity Type | Individual
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Provider Name | GARY J GANIBAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 175 E NASA BLVD STE 201
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City | MELBOURNE
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State | FL
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Zip | 32901-1998
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Country | US
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Telephone | 321-999-7456
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Fax |
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Provider Business Mailing Address
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Address Line | 175 E NASA BLVD STE 201
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City | MELBOURNE
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State | FL
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Zip | 32901-1998
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Country | US
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Telephone | 321-999-7456
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | DR.0057603
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | ME0076850
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME0076850
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License Number State | FL
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