Provider Demographics
NPI:1871573840
Name:VALDES, GERARDO ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:ALBERTO
Last Name:VALDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4796 SW 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3209
Mailing Address - Country:US
Mailing Address - Phone:754-333-9213
Mailing Address - Fax:
Practice Address - Street 1:7101 W MCNAB RD STE 101
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5351
Practice Address - Country:US
Practice Address - Phone:954-722-5600
Practice Address - Fax:954-721-7790
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIX725ZOtherMEDICARE
FL020369500Medicaid
FLIX725ZOtherMEDICARE