Provider Demographics
NPI:1093891954
Name:GERTSON, DAWN RACHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:RACHELLE
Last Name:GERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:HOSPITAL SPECIALISTS-KMC KOOTENAI MEDICAL CTR
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-666-3378
Mailing Address - Fax:208-666-4037
Practice Address - Street 1:2003 KOOTENAI HEALTH WAY
Practice Address - Street 2:HOSPITAL SPECIALISTS-KMC KOOTENAI MEDICAL CTR
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-666-3378
Practice Address - Fax:208-666-4037
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036119207PE0004X
IDM10549207R00000X
WAMD00024022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
C91507Medicare UPIN