Provider Demographics
NPI:1316991144
Name:GERR, FREDRIC ETHAN (MD)
Entity type:Individual
Prefix:
First Name:FREDRIC
Middle Name:ETHAN
Last Name:GERR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4187
Mailing Address - Fax:319-353-6406
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4187
Practice Address - Fax:319-353-6406
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34710207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55844OtherWELLMARK BCBS
IA0272484Medicaid
A96159Medicare UPIN
IAI0923200Medicare PIN
IA0272484Medicaid
IA250013771Medicare PIN