Individual
DR. THOR C GJERDRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 SOUTH STRATFORD AVENUE, SANTA MARIA, CA 93454-5903
(805) 739-3863
(805) 614-2035
Mailing address
504 PLAZA DR, SANTA MARIA, CA 93454-6917
(805) 739-3863
(805) 614-2035
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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