Provider Demographics
NPI:1770643413
Name:TELEP, GERALD NANSON (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:NANSON
Last Name:TELEP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 RIVER PLAZA DR
Mailing Address - Street 2:APT. 107
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3267
Mailing Address - Country:US
Mailing Address - Phone:916-925-8845
Mailing Address - Fax:
Practice Address - Street 1:1675 ALHAMBRA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7047
Practice Address - Country:US
Practice Address - Phone:916-451-4580
Practice Address - Fax:916-451-3119
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34834207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery