Basic Information
| Provider Information | |||||||||
| NPI: | 1134137003 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERRISH | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 82183 | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997082183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074793373 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1408 19TH AVE | ||||||||
| Address2: | TANANA CHIEFS CONFERENCE | ||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074516682 | ||||||||
| FaxNumber: | 9074593811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 09/28/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 1839 | AK | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 1839 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.