Provider Demographics
NPI:1144229881
Name:GERBER, ALLEN DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DEAN
Last Name:GERBER
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 1:1002 SCHNEIDER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-4823
Mailing Address - Country:US
Mailing Address - Phone:501-332-1012
Mailing Address - Fax:501-332-7074
Practice Address - Street 1:1001 SCHNEIDER DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-4811
Practice Address - Country:US
Practice Address - Phone:501-332-1012
Practice Address - Fax:501-332-7074
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2012-02-27
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
ARN8012208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190140002Medicaid
ARB68245Medicare UPIN
AR539486968Medicare PIN