Provider Demographics
NPI:1366679995
Name:GERTSCH, KEVIN RAY (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RAY
Last Name:GERTSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9065 DEVONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-4825
Mailing Address - Country:US
Mailing Address - Phone:319-356-8264
Mailing Address - Fax:319-356-0363
Practice Address - Street 1:1485 JESSE JEWELL PKWY NE
Practice Address - Street 2:STE 100
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3801
Practice Address - Country:US
Practice Address - Phone:770-564-1711
Practice Address - Fax:770-534-9158
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2016-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
GA076038207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program