Provider Demographics
NPI:1053320739
Name:GERSCH, DARON W (MD)
Entity Type:Individual
Prefix:
First Name:DARON
Middle Name:W
Last Name:GERSCH
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 1:320 3RD AVENUE
Mailing Address - Street 2:CENTRACARE CLINIC-ALBANY
Mailing Address - City:ALBANY
Mailing Address - State:MN
Mailing Address - Zip Code:56307-9363
Mailing Address - Country:US
Mailing Address - Phone:320-845-2157
Mailing Address - Fax:320-845-6138
Practice Address - Street 1:320 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9363
Practice Address - Country:US
Practice Address - Phone:320-845-2157
Practice Address - Fax:320-845-6138
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN37125207Q00000X
MN37125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110372OtherUCARE
MN574220000Medicaid
MN0101029OtherMEDICA
MN1006145OtherPREFERRED ONE
MN6T068GEOtherBLUE CROSS
MNHP10474OtherHEALTH PARTNERS
MNP00140547OtherRAILROAD MC
MN110372OtherUCARE
MN80013004Medicare ID - Type Unspecified