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NPI Code Detail

MEDICARE: DR. K GERSTENBERG D.O.

MEDICARE: DR. K GERSTENBERG D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianJ6456TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28K9900OTHERTXBCBS INDIVDUAL NUMBER

General Provider Information

NPI Number : 1265430649
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. K GERSTENBERG D.O.
Provider Business Mailing Address
First Line : 2645 NALL ST
Second Line :
City : PORT NECHES
State : TX
Zip : 77651-4707
Country : US
Telephone Number : 409-210-3336
Fax Number : 409-527-3969
Provider Business Practice Location Address
First Line : 2645 NALL ST
Second Line :
City : PORT NECHES
State : TX
Zip : 77651-4707
Country : US
Telephone Number : 409-210-3336
Fax Number : 409-527-3969
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 03/04/2025

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