Provider Demographics
NPI:1659366888
Name:LONDON, GERALD F (MD FACP)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:F
Last Name:LONDON
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:F
Other - Last Name:LONDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD FACP
Mailing Address - Street 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-246-6777
Mailing Address - Fax:423-246-7766
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-246-6777
Practice Address - Fax:423-246-7766
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD020536207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64922735Medicaid
TNTN0104OtherUNITED HEALTHCARE RIVER V
TN000135151OtherBCBS OF TN
TN3700033Medicaid
KY000000053386OtherANTHEM
VA006037020Medicaid
TN100010622OtherPHP TENNCARE
WV1830464000Medicaid
VA058719OtherANTHEM
TN4675259OtherAETNA
TND76269Medicare UPIN
KY64922735Medicaid
TN3700033Medicaid