Provider Demographics
NPI:1790728277
Name:GERBERICH, BRADLEY K (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:K
Last Name:GERBERICH
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 1:100 W. CALIFORNIA BLVD.
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:818-585-9526
Mailing Address - Fax:818-706-1680
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:818-585-9562
Practice Address - Fax:818-706-1680
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61036207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE828YMedicare PIN
A53632Medicare UPIN
WG61036EMedicare PIN
CAA53632Medicare UPIN