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Individual

DR. MARY ELIZABETH GERARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
333 N 18TH AVE STE B4, POCATELLO, ID 83201
(208) 232-2233
(208) 232-2299
Mailing address
333 N 18TH AVE, STE B4, POCATELLO, ID 83201
(208) 232-2233
(208) 232-2299

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
M7059
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010008867
BLUE SHIELD
ID
05
002119100
ID
01
70599
BLUE CROSS
ID
Enumeration date
09/11/2006
Last updated
06/08/2016
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