Provider Demographics
NPI:1851557722
Name:VANDER VELDE, GERRY M (MD)
Entity Type:Individual
Prefix:DR
First Name:GERRY
Middle Name:M
Last Name:VANDER VELDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9630 BRUCEVILLE RD
Mailing Address - Street 2:STE 106-186
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5512
Mailing Address - Country:US
Mailing Address - Phone:775-527-5145
Mailing Address - Fax:
Practice Address - Street 1:9630 BRUCEVILLE RD
Practice Address - Street 2:STE 106-186
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5512
Practice Address - Country:US
Practice Address - Phone:775-527-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-115001207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine