Provider Demographics
NPI:1972577286
Name:GERDES, MELISSA SUSAN (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUSAN
Last Name:GERDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 HOSPITAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5408
Mailing Address - Country:US
Mailing Address - Phone:916-684-1600
Mailing Address - Fax:916-681-1765
Practice Address - Street 1:7601 HOSPITAL DR STE 103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5408
Practice Address - Country:US
Practice Address - Phone:166-841-6009
Practice Address - Fax:916-681-1765
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2699207Q00000X
CAC151203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X9681OtherBLUE CROSS OF TEXAS
TX134290909Medicaid
G55718Medicare UPIN
TXTXB129911Medicare PIN