Provider Demographics
NPI:1154369395
Name:GERRY, DONALD R (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:GERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16525 S 106TH COURT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-226-6977
Mailing Address - Fax:708-226-1372
Practice Address - Street 1:16525 106TH CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4545
Practice Address - Country:US
Practice Address - Phone:708-226-6977
Practice Address - Fax:708-226-1372
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083184Medicaid
IL036083184Medicaid
ILL62033Medicare PIN