Basic Information
| Provider Information | |||||||||
| NPI: | 1184617904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERSON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15416 N FLORIDA AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336131244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139602400 | ||||||||
| FaxNumber: | 8139602410 | ||||||||
| Practice Location | |||||||||
| Address1: | 15416 N FLORIDA AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336131244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139602400 | ||||||||
| FaxNumber: | 8139602410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 35059192 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 207QH0002X | ME93072 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207RH0002X | ME93072 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 2085R0001X | 32917 | KY | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 01052989A | IN | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | ME93072 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 64954902 | 05 | KY | MEDICAID | 200070450 | 05 | IN | MEDICAID | 0909922 | 05 | OH | MEDICAID |