Provider Demographics
NPI:1265670061
Name:M ELIZABETH GERARD MD PLLC
Entity Type:Organization
Organization Name:M ELIZABETH GERARD MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-233-8344
Mailing Address - Street 1:333 N 18TH AVE
Mailing Address - Street 2:STE B4
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-232-2233
Mailing Address - Fax:208-232-2299
Practice Address - Street 1:333 N 18TH AVE
Practice Address - Street 2:STE B4
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-232-2233
Practice Address - Fax:208-232-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-70592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty