Provider Demographics
NPI:1467707034
Name:GERSON, STEVEN E (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:GERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 S VIRGINIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2820
Mailing Address - Country:US
Mailing Address - Phone:702-622-0338
Mailing Address - Fax:
Practice Address - Street 1:1699 S VIRGINIA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2820
Practice Address - Country:US
Practice Address - Phone:702-622-0338
Practice Address - Fax:775-853-4010
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1250207R00000X
CA20A6294207R00000X
NJ25MB04750200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVD19317Medicare UPIN