1255390357 NPI number — DR. JEAN M GERHARD M.D.

Table of content: DR. JEAN M GERHARD M.D. (NPI 1255390357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255390357 NPI number — DR. JEAN M GERHARD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERHARD
Provider First Name:
JEAN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRARA
Provider Other First Name:
JEAN
Provider Other Middle Name:
MURRAY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255390357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6130 W PARKER RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-7901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-468-8158
Provider Business Mailing Address Fax Number:
972-473-4808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3004 COMMUNICATIONS PKWY
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-8909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-468-8158
Provider Business Practice Location Address Fax Number:
972-473-4808
Provider Enumeration Date:
03/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  K6582 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 139001503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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