Healthcare Provider Details

I. General information

NPI: 1417043191
Provider Name (Legal Business Name): STEPHEN K GERARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SULLIVAN AVE SETON PATHOLOGY DEPT
DALY CITY CA
94015
US

IV. Provider business mailing address

PO BOX 29471
SAINT LOUIS MO
63126-7471
US

V. Phone/Fax

Practice location:
  • Phone: 650-991-6685
  • Fax:
Mailing address:
  • Phone: 888-843-8475
  • Fax: 844-410-3798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberG50781
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberG50781
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberG50781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: