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General NPI Number Information
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NPI Number | 1639533391
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Entity Type | Individual
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Provider Name | MATTHEW GERDES
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Gender | Male
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 04/08/2016
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Provider Practice Location Address
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Address Line | 705 BRADBURY LN
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City | SPARTA
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State | IL
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Zip | 62286-2102
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Country | US
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Telephone | 618-443-3088
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Fax |
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Provider Business Mailing Address
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Address Line | 4156 WATER OAK LN
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City | SMITHTON
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State | IL
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Zip | 62285-3666
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Country | US
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Telephone | 618-670-0561
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 0000935841
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | P-16058
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License Number State | MO
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