Healthcare Provider Details

I. General information

NPI: 1972064285
Provider Name (Legal Business Name): BRET GERSTNER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BROADWAY STE 240
COLUMBIA MO
65201-8022
US

IV. Provider business mailing address

1601 E BROADWAY STE 240
COLUMBIA MO
65201-8022
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8145
  • Fax: 573-815-3832
Mailing address:
  • Phone: 573-815-8145
  • Fax: 573-815-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: