Provider Demographics
NPI:1134190440
Name:YORK, GERALD EDWARD II (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EDWARD
Last Name:YORK
Suffix:II
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 1:3650 PIPER STREET SUITE A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-222-4624
Mailing Address - Fax:907-222-4651
Practice Address - Street 1:3650 PIPER STREET SUITE A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-222-4624
Practice Address - Fax:907-222-4651
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM55972085D0003X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7617025Medicaid
ID808256800Medicaid
OK8VGJWWO5AMedicaid
OK200105670 BMedicaid
TX1939340 03Medicaid
MD226608300Medicaid
OH2902121Medicaid
TXTXB102339Medicare PIN
I71977Medicare UPIN
OK200105670 BMedicaid
TX8L11730Medicare PIN
MD226608300Medicaid