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GERERON JERALD DAW MT

Medical Technologist >> Specialist/Technologist, Pathology >> Technologists, Technicians & Other Technical Service Providers

Registrant NPI Number: 1245746114

Individual Registrant:
 GERERON JERALD DAW MT
Gender: M
Not Sole Proprietor

Location and contact information for practice:
394.3 HIGHWAY 160  KAYENTA, AZ 86033 US
Tel: 928-697-4140  Fax: 928-697-4142

Contact information for business:
PO BOX 368  KAYENTA, AZ 86033-0368 US
Tel: 928-697-4140  Fax: --

Registration Information:
NPI: 1245746114
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y246QM0706XTechnologists, Technicians & Other Technical Service Providers
Specialist/Technologist, Pathology
Medical Technologist
213216

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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