MEDICARE: JASON L. GERBOC D.O.

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	208800000X	Urology Physician	OS012897	PA
2	208800000X	Urology Physician	OS12668	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00226465	OTHER	PA	RAILROAD MEDICARE
4	P01092454	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2392880000	OTHER	PA	KEYSTONE IBC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1724365	OTHER	PA	HIGHMARK BLUE SHIELD
7	8460478	OTHER	PA	AETNA HMO
8	1724365	OTHER	PA	PERSONAL CHOICE
9	8460478	OTHER	PA	AETNA NON HMO
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548374325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON L. GERBOC D.O.

Provider Business Mailing Address
First Line	:	1210 WATERMAN WAY
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5229
Country	:	US
Telephone Number	:	352-343-2364
Fax Number	:	352-343-0548

Provider Business Practice Location Address
First Line	:	1210 WATERMAN WAY
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5229
Country	:	US
Telephone Number	:	352-343-2364
Fax Number	:	352-343-0548

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/20/2014

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Directions to “ JASON L. GERBOC D.O.” Practice Location

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