Healthcare Provider Details

I. General information

NPI: 1487642468
Provider Name (Legal Business Name): DAVID D. GERBRACHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 DUFF AVE
AMES IA
50010-5733
US

IV. Provider business mailing address

1015 DUFF AVE
AMES IA
50010-5733
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4775
  • Fax: 515-239-4420
Mailing address:
  • Phone: 515-239-4775
  • Fax: 515-239-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number26989
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: