Provider Demographics
NPI:1194867580
Name:GERNERT, JOHN NORMAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NORMAN
Last Name:GERNERT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 KEITH ST NW STE 3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1704
Mailing Address - Country:US
Mailing Address - Phone:423-476-3773
Mailing Address - Fax:423-476-8529
Practice Address - Street 1:105 KEITH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-1704
Practice Address - Country:US
Practice Address - Phone:423-476-3773
Practice Address - Fax:423-476-8529
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM000000198213E00000X
TN198213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1194867580Medicaid
TN103G703357OtherPTAN
TN1629408703Medicaid
TN3350757OtherPTAN
TNT61072OtherUPIN