Healthcare Provider Details

I. General information

NPI: 1710198932
Provider Name (Legal Business Name): ROYCE MARTIN GERBITZ B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W 96TH AVE
THORNTON CO
80260-5469
US

IV. Provider business mailing address

2090 POZE BLVD
THORNTON CO
80229-4651
US

V. Phone/Fax

Practice location:
  • Phone: 303-427-1386
  • Fax:
Mailing address:
  • Phone: 303-824-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: