Provider Demographics
NPI:1780614354
Name:GERSON, ROBERT S (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:GERSON
Suffix:
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 1:2929 N. POWER RD.
Mailing Address - Street 2:SUITE C-12
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215
Mailing Address - Country:US
Mailing Address - Phone:480-291-4744
Mailing Address - Fax:888-361-4566
Practice Address - Street 1:2929 N. POWER RD.
Practice Address - Street 2:SUITE C-12
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215
Practice Address - Country:US
Practice Address - Phone:480-291-4744
Practice Address - Fax:888-361-4566
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30542207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ726903Medicaid
AZ726903Medicaid
AZ71818Medicare PIN
AZP00199031Medicare PIN
AZZ119386Medicare PIN
AZZ71818Medicare PIN