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Individual
DR. THOR C GJERDRUM
Active
Individual
DR. THOR C GJERDRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G16055
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G160550
—
CA
01
—
WG16055I
MEDICARE ID
CA
01
—
ZZZ06481Z
BLUE SHIELD GROUP PIN
CA
Enumeration date
12/05/2005
Last updated
02/15/2016
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