Healthcare Provider Details

I. General information

NPI: 1528066792
Provider Name (Legal Business Name): ERIC ALLAN GERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 N 7TH ST
GRAND JUNCTION CO
81501-8209
US

IV. Provider business mailing address

2530 N 8TH ST SUITE 101
GRAND JUNCTION CO
81501-8857
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-9729
  • Fax:
Mailing address:
  • Phone: 970-241-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number9771
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number9771
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: