Provider Demographics
NPI:1982893053
Name:ROBERT S. GERSON MD PC
Entity Type:Organization
Organization Name:ROBERT S. GERSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-276-2667
Mailing Address - Street 1:2931 N TENAYA WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0456
Mailing Address - Country:US
Mailing Address - Phone:800-482-2857
Mailing Address - Fax:702-387-8763
Practice Address - Street 1:7130 E SADDLEBACK ST
Practice Address - Street 2:#16
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-1038
Practice Address - Country:US
Practice Address - Phone:480-361-4283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30542207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ726903Medicaid
AZ119385Medicare PIN
AZ726903Medicaid