MEDICARE: GB MEDICAL LLC

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	207R00000X	Internal Medicine Physician	ME100498	FL

General Provider Information

NPI Number	:	1922484872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GB MEDICAL LLC

Provider Business Mailing Address
First Line	:	1504 BAY RD
Second Line	:	APT 2410
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3399
Country	:	US
Telephone Number	:	516-263-8742
Fax Number	:

Provider Business Practice Location Address
First Line	:	8216 WORLD CENTER DR
Second Line	:	SUITE D
City	:	ORLANDO
State	:	FL
Zip	:	32821-5412
Country	:	US
Telephone Number	:	321-932-1893
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARTH G BECKER
Credential	:	MD
Telephone Number	:	516-263-8742

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	08/03/2015

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