Provider Demographics
NPI:1184617904
Name:GERSON, JENNIFER W (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:W
Last Name:GERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15416 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1244
Mailing Address - Country:US
Mailing Address - Phone:813-960-2400
Mailing Address - Fax:813-960-2410
Practice Address - Street 1:15416 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1244
Practice Address - Country:US
Practice Address - Phone:813-960-2400
Practice Address - Fax:813-960-2410
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350591922085R0001X
FLME93072207QH0002X, 207RH0002X, 2085R0001X
KY329172085R0001X
IN01052989A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64954902Medicaid
IN200070450Medicaid
OH0909922Medicaid
OH4041031Medicare PIN
F24107Medicare UPIN
OH0909922Medicaid
INM400028321Medicare PIN