Healthcare Provider Details

I. General information

NPI: 1063857571
Provider Name (Legal Business Name): JONATHAN A. GERBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 HARBORSIDE DR
GALVESTON TX
77555-0001
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-0859
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-6781
  • Fax:
Mailing address:
  • Phone: 409-772-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberR6009
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberR6009
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: