1275577652 NPI number — DR. JOHN MARTIN GEHRIS M.D.

Table of content: DR. JOHN MARTIN GEHRIS M.D. (NPI 1275577652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275577652 NPI number — DR. JOHN MARTIN GEHRIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEHRIS
Provider First Name:
JOHN
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275577652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 QUAKER LN
Provider Second Line Business Mailing Address:
SUITE 207-C
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27262-3832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-883-2500
Provider Business Mailing Address Fax Number:
336-883-9728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 WESTWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27262-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-882-2433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006

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: 207R00000X , with the licence number:  0097-00559 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25532 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00160957 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 743605 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8911763 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: D4635 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1091482 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11763 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4022025 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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