Provider Demographics
NPI:1629385836
Name:PRETORIUS, GERT DIEDERICK VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:GERT
Middle Name:DIEDERICK VICTOR
Last Name:PRETORIUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 WEST ARBOR DR
Mailing Address - Street 2:MC 8892
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9001
Mailing Address - Country:US
Mailing Address - Phone:619-543-7777
Mailing Address - Fax:619-543-2652
Practice Address - Street 1:200 WEST ARBOR DR
Practice Address - Street 2:MC 8892
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-7777
Practice Address - Fax:619-543-2652
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2011-05-19
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Provider Licenses
StateLicense IDTaxonomies
CA113774208G00000X
CAA113774208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)