Provider Demographics
NPI:1669415642
Name:MAYER, GERALD THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:THOMAS
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13022 JONES MALTSBERGER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4219
Mailing Address - Country:US
Mailing Address - Phone:210-491-0772
Mailing Address - Fax:
Practice Address - Street 1:13022 JONES MALTSBERGER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4219
Practice Address - Country:US
Practice Address - Phone:210-491-0772
Practice Address - Fax:210-481-2769
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ3154207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D04250Medicare UPIN