Provider Demographics
NPI:1982670220
Name:ROBERTS, GERALD S (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:S
Last Name:ROBERTS
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 1:2186 GEARY BLVD STE 314
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3457
Mailing Address - Country:US
Mailing Address - Phone:415-929-0600
Mailing Address - Fax:415-929-8106
Practice Address - Street 1:2186 GEARY BLVD STE 314
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3457
Practice Address - Country:US
Practice Address - Phone:415-929-0600
Practice Address - Fax:415-929-8106
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26452207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A264520Medicaid
CA00A264520Medicaid
CA00A264520Medicare PIN