Healthcare Provider Details

I. General information

NPI: 1609347012
Provider Name (Legal Business Name): DANIEL J. GERWING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1521 9TH AVE N
SARTELL MN
56377-1400
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-5099
  • Fax:
Mailing address:
  • Phone: 605-651-3693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12869
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: