Provider Demographics
NPI:1518941350
Name:GERBER, ROBERT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
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 1:2690 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2134
Mailing Address - Country:US
Mailing Address - Phone:541-269-5333
Mailing Address - Fax:541-269-5609
Practice Address - Street 1:2690 N 17TH ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-269-5333
Practice Address - Fax:541-269-5609
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00088023OtherRR MEDICARE PTAN NUMBER
ORCB3544OtherRR MEDICARE GROUP NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN
OR047899Medicaid
OR1407812365OtherNBMC NPI NUMBER-GROUP
ORR0000WFBTVOtherMEDICARE GROUP PIN
ORR111968Medicare PIN
ORF25167Medicare UPIN
OR0577260001Medicare NSC