Provider Demographics
NPI:1689709982
Name:ARDRON, GERARD EMILE (MD)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:EMILE
Last Name:ARDRON
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 1:940 SYLVA LN STE G
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5969
Mailing Address - Country:US
Mailing Address - Phone:209-532-2020
Mailing Address - Fax:
Practice Address - Street 1:940 SYLVA LN STE G
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5969
Practice Address - Country:US
Practice Address - Phone:209-532-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66625207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G666250Medicaid
CA1299310002OtherSECOND DMERC NORIDIAN
CA180029904OtherRAILROAD MEDICARE PIN
CA00G666251Medicaid
CA1299310001OtherDMERC NORIDIAN
CA00G666251Medicaid
CA1299310001OtherDMERC NORIDIAN
CA00G666250Medicare PIN
CA1299310002OtherSECOND DMERC NORIDIAN