Provider Demographics
NPI:1134181571
Name:GERDES, JEFFREY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:GERDES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 SIXTH AVE N
Mailing Address - Street 2:CENTRACARE CLINIC RIVER CAMPUS/NEROSURGERY
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:302-240-2826
Mailing Address - Fax:320-259-5896
Practice Address - Street 1:1200 SIXTH AVE N
Practice Address - Street 2:CENTRACARE CLINIC RIVER CAMPUS/NEROSURGERY
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-259-1405
Practice Address - Fax:320-259-5896
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-12-18
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Provider Licenses
StateLicense IDTaxonomies
MN37735207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG05452Medicare UPIN