MEDICARE: ADAM GARETT GORBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	0101247626	VA
2	207L00000X	Anesthesiology Physician	ME102397	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	HR825Z	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14TL0	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477875979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM GARETT GORBERG M.D.

Provider Business Mailing Address
First Line	:	6227 VISTA VERDE DR W
Second Line	:
City	:	GULFPORT
State	:	FL
Zip	:	33707-6908
Country	:	US
Telephone Number	:	914-450-8504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2438 DR MARTIN LUTHER KING JR ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704
Country	:	US
Telephone Number	:	727-547-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	05/31/2018

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Directions to “ ADAM GARETT GORBERG M.D.” Practice Location

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