Gerald Benjamin Doersam, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

A49166 Issued in CA

Practice address

830 Scenic Dr
Modesto, CA 95350-6131

Phone

(209) 558-7164

Fax

(209) 558-8723

NPI assigned

Jun 9, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Gerald Benjamin Doersam Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307577600000",
    "number": "1245525088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506131",
            "telephone_number": "209-558-7164",
            "fax_number": "209-558-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 SCENIC DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953506131",
            "telephone_number": "209-558-7164",
            "fax_number": "209-558-8723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOERSAM",
        "first_name": "GERALD",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-09",
        "last_updated": "2011-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A49166",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ZZ",
            "license": "08271",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GERALD",
            "last_name": "DOERSAM",
            "middle_name": "BENJAMIN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Doctors Medical Center of Modesto, Inc. (Doctors Behavioral Health Center)
• Doctors Medical Center of Modesto, Inc. (DMC Professional Billing)
• Doctors Primary Care of Modesto, Inc. (Doctors Primary Care Center)
• Chathuri Senanayake Dodam Mullage, MD
• Jeffrey Alan Doelling, MD
• Rupali Dogra
• Mariah Lynn Dolin
• Brian E. Dolnick, DO
• Doman & Wilson Psychological Service Inc (Psych Solutions)
• Josiah Steven Doman, PSY.D.

• Obstetrics & Gynecology Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; 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.