Provider Demographics
NPI:1144218892
Name:GERENCER, ROLAND ZSOLT (MD)
Entity type:Individual
Prefix:
First Name:ROLAND
Middle Name:ZSOLT
Last Name:GERENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3065
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:2250 OSPREY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4340
Practice Address - Country:US
Practice Address - Phone:863-904-6296
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME175645207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040014203OtherGBA PALMETTO - RAILROAD MEDICARE
NM201021487OtherPRESBYTERIAN HEALTH PLAN
NMNM024902OtherBCBS
NMZ6104Medicaid
NMZ6104Medicaid
040014203OtherGBA PALMETTO - RAILROAD MEDICARE