Provider Demographics
NPI:1992765010
Name:GERSON, DAVID B (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:GERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4316
Mailing Address - Country:US
Mailing Address - Phone:501-812-7800
Mailing Address - Fax:
Practice Address - Street 1:1308 E KIEHL AVE
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3040
Practice Address - Country:US
Practice Address - Phone:501-835-0703
Practice Address - Fax:501-834-6249
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36509868Medicaid
AR150121003Medicaid
5M614Medicare ID - Type Unspecified
CO36509868Medicaid
AR150121003Medicaid
ARP00040775Medicare UPIN
COP00675767Medicare PIN