Provider Demographics
NPI:1962698035
Name:PAUL C GERING, JR., MD
Entity type:Organization
Organization Name:PAUL C GERING, JR., MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GERING
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:541-889-0771
Mailing Address - Street 1:1077 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2125
Mailing Address - Country:US
Mailing Address - Phone:541-889-0771
Mailing Address - Fax:541-889-8788
Practice Address - Street 1:1077 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2125
Practice Address - Country:US
Practice Address - Phone:541-889-0771
Practice Address - Fax:541-889-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR067590Medicaid
ID003426600Medicaid
080088293OtherRAILROAD MEDICARE
080088293OtherRAILROAD MEDICARE