MEDICARE: ERIC A. GERSON, MD LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE7931	OTHER	NV	RAILROAD MEDICARE
2	V102219	OTHER	NV	MEDICARE LEGACY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447209499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC A. GERSON, MD LTD

Provider Business Mailing Address
First Line	:	DEPT 8191
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-0001
Country	:	US
Telephone Number	:	888-727-1075
Fax Number	:	702-990-4947

Provider Business Practice Location Address
First Line	:	1409 E LAKE MEAD BLVD
Second Line	:	IMAGING DEPARTMENT
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-7120
Country	:	US
Telephone Number	:	702-657-5507
Fax Number	:	702-649-3480

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC A GERSON
Credential	:	MD
Telephone Number	:	702-897-2081

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	02/12/2009

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