Basic Information
Provider Information
NPI: 1255654737
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GERBER
FirstName: ZEROMEH
MiddleName: LORELEI
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CAMPBELL
OtherFirstName: ZEROMEH
OtherMiddleName: LORELEI
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 1
Mailing Information
Address1: 653 N TOWN CENTER DR
Address2: SUITE 112
City: LAS VEGAS
State: NV
PostalCode: 891440514
CountryCode: US
TelephoneNumber: 7027330981
FaxNumber:  
Practice Location
Address1: 653 N TOWN CENTER DR
Address2: SUITE 112
City: LAS VEGAS
State: NV
PostalCode: 891440514
CountryCode: US
TelephoneNumber: 7027330981
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/11/2010
LastUpdateDate: 08/17/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080N0001X16381NVY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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