Provider Demographics
NPI:1205834843
Name:GERSTMANN, DALE R (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:GERSTMANN
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 1:730 W 800 N STE 340B
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-6300
Mailing Address - Country:US
Mailing Address - Phone:801-655-5425
Mailing Address - Fax:801-655-5426
Practice Address - Street 1:750 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3660
Practice Address - Country:US
Practice Address - Phone:801-714-6511
Practice Address - Fax:801-714-6597
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184816-1205208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD1500Medicare UPIN