MEDICARE: HELENE GERRALD DO

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	207P00000X	Emergency Medicine Physician	363	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568438448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELENE GERRALD DO

Provider Business Mailing Address
First Line	:	4615 OLEANDER DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5741
Country	:	US
Telephone Number	:	843-497-5929
Fax Number	:	843-497-9940

Provider Business Practice Location Address
First Line	:	5050 HIGHWAY 17 S
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-4910
Country	:	US
Telephone Number	:	843-497-5929
Fax Number	:	843-497-9940

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	10/23/2007

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Directions to “ HELENE GERRALD DO” Practice Location

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