Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G50397 | CA |
NPI | 1417950064 |
---|---|
Provider Name | Dr. Larry Marc Gersten |
First Address | Laguna Woods, CA 92637-3116 |
Second Address | Laguna Woods, CA 92637-3116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 19/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G503970 | (05) | CA |
00G503970G89 | CAL-OPTIMA (01) | CA |
A92972 | (02) | CA |
RR2000 19525 | MEDICARE RAILROAD (01) | CA |