MEDICARE: DR. GERALD THOMAS NEEDHAM JR. 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	207RN0300X	Nephrology Physician	OS7262	FL

General Provider Information

NPI Number	:	1962427195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD THOMAS NEEDHAM JR. D.O.

Provider Business Mailing Address
First Line	:	1305 S FORT HARRISON AVE
Second Line	:	BUILDING H
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3301
Country	:	US
Telephone Number	:	727-441-0104
Fax Number	:	727-441-8272

Provider Business Practice Location Address
First Line	:	1305 S FORT HARRISON AVE
Second Line	:	BUILDING H
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3301
Country	:	US
Telephone Number	:	727-441-0104
Fax Number	:	727-441-8272

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/06/2008

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