Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | P8585 | TX |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | P8585 | TX |
NPI | 1265592570 |
---|---|
Provider Name | Dr. Gregg Gordon Gerasimon |
First Address | San Antonio, TX 78234-4504 |
Second Address | San Antonio, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 02/05/2014 |