Provider Demographics
NPI:1376595207
Name:GERSTEIN, DOUGLAS DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DAVID
Last Name:GERSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:49 DUNFRIES TER
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2415
Mailing Address - Country:US
Mailing Address - Phone:415-459-7788
Mailing Address - Fax:415-459-7788
Practice Address - Street 1:49 DUNFRIES TER
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2415
Practice Address - Country:US
Practice Address - Phone:415-459-7788
Practice Address - Fax:415-459-7788
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG24353207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42236Medicare UPIN
CA0198720001Medicare PIN