Healthcare Provider Details

I. General information

NPI: 1528123593
Provider Name (Legal Business Name): DANIEL J GERBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6658 GUNPARK DR SUITE 102
BOULDER CO
80301-3385
US

IV. Provider business mailing address

PO BOX 1588
BOULDER CO
80306-1588
US

V. Phone/Fax

Practice location:
  • Phone: 303-449-4048
  • Fax:
Mailing address:
  • Phone: 303-442-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number31508
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01315084
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: