Provider Demographics
NPI:1265430649
Name:GERSTENBERG, K (DO)
Entity type:Individual
Prefix:DR
First Name:K
Middle Name:
Last Name:GERSTENBERG
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 NALL ST
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-4707
Mailing Address - Country:US
Mailing Address - Phone:409-210-3336
Mailing Address - Fax:409-527-3969
Practice Address - Street 1:2645 NALL ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-4707
Practice Address - Country:US
Practice Address - Phone:409-210-3336
Practice Address - Fax:409-527-3969
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042775906Medicaid
TX8K9900OtherBCBS INDIVDUAL NUMBER
TX8K9900OtherBCBS INDIVDUAL NUMBER
G00344Medicare UPIN