Provider Demographics
NPI:1962594887
Name:GERDSEN, JON D (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:D
Last Name:GERDSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:67-1123 MAMALAHOA HWY
Mailing Address - Street 2:STE 128
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8451
Mailing Address - Country:US
Mailing Address - Phone:808-887-6460
Mailing Address - Fax:808-887-6441
Practice Address - Street 1:67-1123 MAMALAHOA HWY
Practice Address - Street 2:STE 128
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8451
Practice Address - Country:US
Practice Address - Phone:808-887-6460
Practice Address - Fax:808-887-6441
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI5842208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02481501Medicaid