Healthcare Provider Details

I. General information

NPI: 1487626032
Provider Name (Legal Business Name): GERARD DEMERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NMCSD- EMERGENCY DEPARTMENT-SUITE 118
SAN DIEGO CA
92134-1005
US

IV. Provider business mailing address

3776 MACTIBBY ST
SAN DIEGO CA
92117-6136
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A11662
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02002377A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: