Provider Demographics
NPI:1639359888
Name:TERAN, GERSON AIREL (MD)
Entity Type:Individual
Prefix:DR
First Name:GERSON
Middle Name:AIREL
Last Name:TERAN
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 1:4925 CINDY LEE CV
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7496
Mailing Address - Country:US
Mailing Address - Phone:501-697-5228
Mailing Address - Fax:
Practice Address - Street 1:4925 CINDY LEE CV
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7496
Practice Address - Country:US
Practice Address - Phone:501-697-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10311I9981Medicare PIN