Larry Ernest Gerdom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA0000001329 Issued in TN

Practice address

333 Murfreesboro Rd
Nashville, TN 37210-2834

Phone

(615) 248-1261

Fax

(615) 248-1622

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trevecca Nazarene University

  • Local Education Agency (LEA)
  • Nashville, TN
  • NPI 1033407952
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104900547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 WELLINGTON CT",
            "city": "OLD HICKORY",
            "state": "TN",
            "postal_code": "371384657",
            "telephone_number": "615-758-0476",
            "fax_number": "615-248-1622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 MURFREESBORO RD",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372102834",
            "telephone_number": "615-248-1261",
            "fax_number": "615-248-1622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERDOM",
        "first_name": "LARRY",
        "middle_name": "ERNEST",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA0000001329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dimitrios Georgostathis
• Vanessa Gera, FNP
• Justin Geraghty, MD
• Madelyn Gerber
• Miriam S Gerber, NP
• Mary Gerges
• Mina Gerges, DO
• Dalia Gergis
• Meredith Gerhart, MS, CGC
• Michael Robert Gerlach, ATC, EMT

• Physician Assistant in Nashville, TN
• Providers in Nashville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.