Healthcare Provider Details

I. General information

NPI: 1447209499
Provider Name (Legal Business Name): ERIC A. GERSON, MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 E LAKE MEAD BLVD IMAGING DEPARTMENT
N LAS VEGAS NV
89030-7120
US

IV. Provider business mailing address

DEPT 8191
LOS ANGELES CA
90084-0001
US

V. Phone/Fax

Practice location:
  • Phone: 702-657-5507
  • Fax: 702-649-3480
Mailing address:
  • Phone: 888-727-1075
  • Fax: 702-990-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC A GERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 702-897-2081