Healthcare Provider Details

I. General information

NPI: 1932300670
Provider Name (Legal Business Name): REBECCA ANN GERTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANN OWENS

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E 9TH AVE STE 330
DENVER CO
80220-4068
US

IV. Provider business mailing address

4600 E 9TH AVE STE 330
DENVER CO
80220-4068
US

V. Phone/Fax

Practice location:
  • Phone: 303-563-2760
  • Fax: 303-322-0897
Mailing address:
  • Phone: 303-563-2760
  • Fax: 303-322-0897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1757
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: