Provider Demographics
NPI:1114254000
Name:GERARD, JOHN KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNETH
Last Name:GERARD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N LURING DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6829
Mailing Address - Country:US
Mailing Address - Phone:760-286-9946
Mailing Address - Fax:760-867-2369
Practice Address - Street 1:165 N LURING DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6829
Practice Address - Country:US
Practice Address - Phone:760-286-9946
Practice Address - Fax:760-867-2369
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG070964208D00000X
CAG70964207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice