Healthcare Provider Details

I. General information

NPI: 1770643413
Provider Name (Legal Business Name): GERALD NANSON TELEP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 ALHAMBRA BLVD SUITE B
SACRAMENTO CA
95816-7047
US

IV. Provider business mailing address

2559 RIVER PLAZA DR APT. 107
SACRAMENTO CA
95833-3267
US

V. Phone/Fax

Practice location:
  • Phone: 916-451-4580
  • Fax: 916-451-3119
Mailing address:
  • Phone: 916-925-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG34834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: