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General NPI Number Information
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NPI Number | 1235295668
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Entity Type | Individual
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Provider Name | JERRY ROBERT GERSON MD
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Gender | Male
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1262 BERYL ST #135
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2427
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Country | US
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Telephone | 310-890-2505
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Fax | 310-861-8974
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Provider Business Mailing Address
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Address Line | 1262 BERYL ST #135
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City | REDONDO BEACH
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State | CA
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Zip | 90277-2427
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Country | US
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Telephone | 310-890-2505
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Fax | 310-861-8974
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | G 22706
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License Number State | CA
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