Individual
LUIS GERARDO MARMOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2525 HARBOR BLVD, SUITE # 303, PORT CHARLOTTE, FL 33952-5317
(941) 235-1901
(941) 235-1905
Mailing address
2525 HARBOR BLVD STE 303, PORT CHARLOTTE, FL 33952-5344
(941) 235-1901
(941) 235-1905
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME68622
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040010592
RAILROAD MEDICARE
FL
01
—
P00609303
RAILROAD MEDICARE
FL
01
—
P00913646
RAILROAD MEDICARE
—
Enumeration date
07/03/2006
Last updated
06/04/2015
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