Provider Demographics
NPI:1497017727
Name:PINEDA, GERSON O (MD)
Entity Type:Individual
Prefix:DR
First Name:GERSON
Middle Name:O
Last Name:PINEDA
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 1:2301 MARSH LANE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:214-269-5353
Mailing Address - Fax:214-269-5354
Practice Address - Street 1:2301 MARSH LANE
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:214-269-5353
Practice Address - Fax:214-269-5354
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEEL191015208600000X
MEMD23088208600000X
TXR2200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery