Provider Demographics
NPI:1750384699
Name:GERSON, GORDON MARTIN JR (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:MARTIN
Last Name:GERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:716 W BUTTERMILK RD
Mailing Address - Street 2:200 BUTTERMILK LANE
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-2710
Mailing Address - Country:US
Mailing Address - Phone:970-544-7388
Mailing Address - Fax:970-544-1585
Practice Address - Street 1:401 CASTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1159
Practice Address - Country:US
Practice Address - Phone:970-544-7388
Practice Address - Fax:970-544-1585
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO39095207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64687341Medicaid
COH28210Medicare UPIN
COG7184Medicare ID - Type Unspecified