Provider Demographics
NPI:1417035023
Name:HOM, GERALD A (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:HOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SULLIVAN AVE RM 209
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2222
Mailing Address - Country:US
Mailing Address - Phone:650-994-2303
Mailing Address - Fax:
Practice Address - Street 1:1800 SULLIVAN AVE RM 209
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2222
Practice Address - Country:US
Practice Address - Phone:650-994-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42318207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G423180Medicaid
F09897Medicare UPIN
00G423180Medicare ID - Type Unspecified