Provider Demographics
NPI:1871579953
Name:GILBERG, RONALD S (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:GILBERG
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 1:14100 FIVAY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-869-2281
Mailing Address - Fax:727-869-3907
Practice Address - Street 1:14100 FIVAY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-869-2281
Practice Address - Fax:727-869-3907
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0053647207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061644301Medicaid
FL061644301Medicaid
FL09840Medicare PIN