Provider Demographics
NPI:1134374432
Name:JERRY D AYERS MD INC.
Entity type:Organization
Organization Name:JERRY D AYERS MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-683-9394
Mailing Address - Street 1:2800 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6204
Mailing Address - Country:US
Mailing Address - Phone:619-683-9394
Mailing Address - Fax:619-683-9228
Practice Address - Street 1:2800 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6204
Practice Address - Country:US
Practice Address - Phone:619-683-9394
Practice Address - Fax:619-683-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42793207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7479140Medicaid
CAAX754Medicare PIN