Healthcare Provider Details

I. General information

NPI: 1205834843
Provider Name (Legal Business Name): DALE R GERSTMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 W 800 N
OREM UT
84057-3660
US

IV. Provider business mailing address

730 W 800 N STE 340B
OREM UT
84057-6300
US

V. Phone/Fax

Practice location:
  • Phone: 801-714-6511
  • Fax: 801-714-6597
Mailing address:
  • Phone: 801-655-5425
  • Fax: 801-655-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number184816-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number184816-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: