Provider Demographics
NPI:1386356400
Name:GERALD, THERON
Entity type:Individual
Prefix:MR
First Name:THERON
Middle Name:
Last Name:GERALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 BALM ST
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4301
Mailing Address - Country:US
Mailing Address - Phone:225-287-9351
Mailing Address - Fax:
Practice Address - Street 1:805 BALM ST
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4301
Practice Address - Country:US
Practice Address - Phone:225-287-9351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator