Provider Demographics
NPI:1316962756
Name:DREYER, JERROLD S (MD)
Entity type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:S
Last Name:DREYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4835 VAN NUYS BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2134
Mailing Address - Country:US
Mailing Address - Phone:818-784-3615
Mailing Address - Fax:818-905-0130
Practice Address - Street 1:4849 VAN NUYS BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2121
Practice Address - Country:US
Practice Address - Phone:818-784-3615
Practice Address - Fax:818-905-0130
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG31161207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G311610Medicaid
CAA44672Medicare UPIN
CAG31161Medicare ID - Type Unspecified