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NPI Code Detail

MEDICARE: DR. THOMAS JEFFERSON GERNON MD

MEDICARE: DR. THOMAS JEFFERSON GERNON MD
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
1207Y00000XOtolaryngology Physician45335AZ
2207Y00000XOtolaryngology PhysicianC139412CA

General Provider Information

NPI Number : 1548387525
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS JEFFERSON GERNON MD
Provider Business Mailing Address
First Line : PO BOX 512185
Second Line :
City : LOS ANGELES
State : CA
Zip : 90051-0185
Country : US
Telephone Number : 626-775-3514
Fax Number : 626-218-5310
Provider Business Practice Location Address
First Line : 209 FAIR OAKS AVE
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-1814
Country : US
Telephone Number : 626-396-2900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 12/14/2020

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