Healthcare Provider Details

I. General information

NPI: 1063479517
Provider Name (Legal Business Name): EDWIN S. GERRISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 1ST AVE SE
WATERTOWN SD
57201-4402
US

IV. Provider business mailing address

506 1ST AVE SE
WATERTOWN SD
57201-4402
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8482
  • Fax: 605-884-4300
Mailing address:
  • Phone: 605-886-8482
  • Fax: 605-884-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1392
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: