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General NPI Number Information
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NPI Number | 1104977602
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Entity Type | Individual
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Provider Name | JERRY DANIEL AYERS MD
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Gender | Male
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 2121 5TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92101-2139
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Country | US
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Telephone | 619-683-9394
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Fax | 619-683-9228
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Provider Business Mailing Address
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Address Line | 2121 5TH AVE STE 105
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City | SAN DIEGO
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State | CA
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Zip | 92101-2139
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Country | US
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Telephone | 619-683-9394
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Fax | 619-683-9228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | A42793
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License Number State | CA
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