Provider Demographics
NPI:1598785065
Name:HERSHEWE, GERARD L (DO)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:L
Last Name:HERSHEWE
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 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 605
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-329-4500
Mailing Address - Fax:775-329-4595
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 605
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-329-4500
Practice Address - Fax:775-329-4595
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV514NV2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016420Medicaid
NVCC1681OtherBLUE CROSS
NVVDO514BMedicare PIN