Healthcare Provider Details

I. General information

NPI: 1114254000
Provider Name (Legal Business Name): JOHN KENNETH GERARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N LURING DR
PALM SPRINGS CA
92262-6829
US

IV. Provider business mailing address

165 N LURING DR
PALM SPRINGS CA
92262-6829
US

V. Phone/Fax

Practice location:
  • Phone: 760-286-9946
  • Fax: 760-867-2369
Mailing address:
  • Phone: 760-286-9946
  • Fax: 760-867-2369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG070964
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberG70964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: