Provider Demographics
NPI:1396909701
Name:GERBER, AMANDA JEAN (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:GERBER
Suffix:
Gender:F
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BONAPARTE
Mailing Address - State:IA
Mailing Address - Zip Code:52620-0250
Mailing Address - Country:US
Mailing Address - Phone:319-677-0219
Mailing Address - Fax:888-965-5450
Practice Address - Street 1:602 8TH ST STE 105
Practice Address - Street 2:
Practice Address - City:BONAPARTE
Practice Address - State:IA
Practice Address - Zip Code:52620-9769
Practice Address - Country:US
Practice Address - Phone:319-677-0219
Practice Address - Fax:888-965-5450
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017010125207P00000X
IAR8459207Q00000X
IA38644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1396909701Medicaid
IA1396909701Medicaid