Provider Demographics
NPI:1235295668
Name:GERSON, JERRY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ROBERT
Last Name:GERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1262 BERYL ST
Mailing Address - Street 2:#135
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2427
Mailing Address - Country:US
Mailing Address - Phone:310-890-2505
Mailing Address - Fax:310-861-8974
Practice Address - Street 1:1262 BERYL ST
Practice Address - Street 2:#135
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2427
Practice Address - Country:US
Practice Address - Phone:310-890-2505
Practice Address - Fax:310-861-8974
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG 22706207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG22706AMedicare ID - Type Unspecified
CAA41684Medicare UPIN