Provider Demographics
NPI:1043356033
Name:GERTSCH, RONALD LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEROY
Last Name:GERTSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 COMPLEX DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1401
Mailing Address - Country:US
Mailing Address - Phone:858-627-0079
Mailing Address - Fax:858-627-0065
Practice Address - Street 1:8705 COMPLEX DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1401
Practice Address - Country:US
Practice Address - Phone:858-627-0079
Practice Address - Fax:858-627-0065
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87819Medicare UPIN