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General NPI Number Information
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NPI Number | 1407431141
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Entity Type | Individual
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Provider Name | ALEXIS NICOLE GHERSI MD
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Gender | Female
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 07/08/2024
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Provider Practice Location Address
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Address Line | 3100 SCHOFIELD RD BLDG 1179
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-7577
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Country | US
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Telephone | 210-916-3160
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Fax |
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Provider Business Mailing Address
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Address Line | 847 E ASHBY PL APT 463
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City | SAN ANTONIO
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State | TX
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Zip | 78212-2046
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Country | US
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Telephone |
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101276943
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License Number State | VA
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