Provider Demographics
NPI:1447209499
Name:ERIC A. GERSON, MD LTD
Entity Type:Organization
Organization Name:ERIC A. GERSON, MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-897-2081
Mailing Address - Street 1:DEPT 8191
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0001
Mailing Address - Country:US
Mailing Address - Phone:888-727-1075
Mailing Address - Fax:702-990-4947
Practice Address - Street 1:1409 E LAKE MEAD BLVD
Practice Address - Street 2:IMAGING DEPARTMENT
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7120
Practice Address - Country:US
Practice Address - Phone:702-657-5507
Practice Address - Fax:702-649-3480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDE7931OtherRAILROAD MEDICARE
NVV102219OtherMEDICARE LEGACY
NV100512276Medicaid
NVV102219OtherMEDICARE LEGACY
NV100512276Medicaid