Individual
ELISA GERDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4504 BOAT CLUB RD STE 800, FORT WORTH, TX 76135-7002
(817) 237-0515
(817) 237-0611
Mailing address
4504 BOAT CLUB RD STE 800, FORT WORTH, TX 76135-7002
(817) 237-0515
(817) 237-0611
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06275
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
323195301
—
TX
Enumeration date
07/22/2009
Last updated
06/23/2014
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