Provider Demographics
NPI:1801043070
Name:GERON, ANTHONY EDWARD (SUBMARINE FORCE IDC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:EDWARD
Last Name:GERON
Suffix:
Gender:M
Credentials:SUBMARINE FORCE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10172 ASHLEY CIR NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9288
Mailing Address - Country:US
Mailing Address - Phone:360-821-8247
Mailing Address - Fax:
Practice Address - Street 1:USS SEAWOLF (SSN 21)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96678
Practice Address - Country:US
Practice Address - Phone:360-476-3915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman