Doctor Name: | DR. JOHN KENNETH GERARD |
NPI Number: | 1114254000 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | G070964 |
Business Practice Address: | 3033 Fifth Ave Suite 105 San Diego, CA - 921035856 |
Business Phone Number: | 6192417979 |
Business Fax Number: | 6192418083 |
Mailing Address: | 3033 Fifth Ave, Suite 105 SAN DIEGO |
State: | CA |
Postal Code: | 921035856 |
Phone Number: | 6192417979 |
Fax Number: | 6192418083 |
NPI Enumeration Date: | 11/12/2009 |
NPI Last Update Date: | 11/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G070964 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |