Provider Demographics
NPI:1639406598
Name:GERRY, DANIEL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:GERRY
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 1:1107 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4351
Mailing Address - Country:US
Mailing Address - Phone:704-752-7575
Mailing Address - Fax:704-752-7576
Practice Address - Street 1:1107 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4351
Practice Address - Country:US
Practice Address - Phone:704-752-7575
Practice Address - Fax:704-752-7576
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-03139207YS0123X
GA006119282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No282N00000XHospitalsGeneral Acute Care Hospital