Healthcare Provider Details

I. General information

NPI: 1992701544
Provider Name (Legal Business Name): ROBERT ALLAN GJERTSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 W 126TH PLACE
OVELAND PARK KS
66209-3230
US

IV. Provider business mailing address

6715 W 126TH PLACE
OVELAND PARK KS
66209-3230
US

V. Phone/Fax

Practice location:
  • Phone: 651-402-3558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number566
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number2012013991
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number12-00393
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number566
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: