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General NPI Number Information
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NPI Number | 1992701544
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Entity Type | Individual
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Provider Name | ROBERT ALLAN GJERTSON DPM
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 6715 W 126TH PLACE
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City | OVELAND PARK
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State | KS
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Zip | 66209-3230
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Country | US
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Telephone | 651-402-3558
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Fax |
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Provider Business Mailing Address
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Address Line | 6715 W 126TH PLACE
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City | OVELAND PARK
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State | KS
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Zip | 66209-3230
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Country | US
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Telephone |
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 566
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 2012013991
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 12-00393
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 566
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License Number State | MN
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