Provider Demographics
NPI:1114978897
Name:GEBHART, RONALD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOHN
Last Name:GEBHART
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 1:500 FOOTHILL DR
Mailing Address - Street 2:CHIEF OF STAFF (11)
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84148-0001
Mailing Address - Country:US
Mailing Address - Phone:801-584-1207
Mailing Address - Fax:801-584-1289
Practice Address - Street 1:500 FOOTHILL DR
Practice Address - Street 2:CHIEF OF STAFF (11)
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-584-1207
Practice Address - Fax:801-584-1289
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3095263-1205207R00000X
GA02525207R00000X
VA0101021971207R00000X
CAG34230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine