Provider Demographics
NPI:1457471443
Name:GERBER, JAIME BLANK (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:BLANK
Last Name:GERBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNN
Other - Last Name:BLANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12345 LAKE CITY WAY NE # 3127
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5401
Mailing Address - Country:US
Mailing Address - Phone:425-333-8849
Mailing Address - Fax:615-544-1280
Practice Address - Street 1:2100 WHARTON ST STE 510
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1691
Practice Address - Country:US
Practice Address - Phone:888-528-7284
Practice Address - Fax:615-544-1280
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235045-1207QG0300X
MEMD22652207QG0300X
MA277564207QG0300X
MDD0088779207QG0300X
WI257-320207QG0300X
VA0101270908207QG0300X
NC2020-03550207QG0300X
WAMD60027256207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0239193OtherL&I
WA1457471443Medicaid
WA0239193OtherL&I