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General NPI Number Information
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NPI Number | 1134181571
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Entity Type | Individual
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Provider Name | JEFFREY S GERDES MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 1200 SIXTH AVE N CENTRACARE CLINIC RIVER CAMPUS/NEROSURGERY
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City | ST CLOUD
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State | MN
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Zip | 56303-2735
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Country | US
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Telephone | 320-259-1405
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Fax | 320-259-5896
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Provider Business Mailing Address
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Address Line | 1200 SIXTH AVE N CENTRACARE CLINIC RIVER CAMPUS/NEROSURGERY
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City | ST CLOUD
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State | MN
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Zip | 56303-2735
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Country | US
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Telephone | 302-240-2826
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Fax | 320-259-5896
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 37735
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License Number State | MN
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