Healthcare Provider Details

I. General information

NPI: 1235198425
Provider Name (Legal Business Name): JOHN W GEBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LYON PLACE RICHARD E WINTER CANCER TREATMENT CENTER
OGDENSBURG NY
13669-2586
US

IV. Provider business mailing address

214 KING ST
OGDENSBURG NY
13669-1142
US

V. Phone/Fax

Practice location:
  • Phone: 315-393-3600
  • Fax: 315-393-0320
Mailing address:
  • Phone: 315-393-3600
  • Fax: 315-393-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2431371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: