Provider Demographics
NPI:1619904661
Name:MADHERE, GESLER LOUIS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:GESLER
Middle Name:LOUIS
Last Name:MADHERE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78595-0250
Mailing Address - Country:US
Mailing Address - Phone:956-485-1401
Mailing Address - Fax:956-485-1407
Practice Address - Street 1:11325 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:SULLIVAN CITY
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-485-1401
Practice Address - Fax:956-485-1407
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant