Provider Demographics
NPI:1881843431
Name:GERSON, SAMUEL JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JEFFREY
Last Name:GERSON
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 1:13119 SUNSTONE PT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5775
Mailing Address - Country:US
Mailing Address - Phone:917-583-5694
Mailing Address - Fax:
Practice Address - Street 1:2878 CAMINO DEL RIO S STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3845
Practice Address - Country:US
Practice Address - Phone:619-241-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116916207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty