Provider Demographics
NPI:1154727923
Name:GERST, GARY (PA-C)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:GERST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1000
Mailing Address - Street 2:251 NORTH ILLINOIS HIGHWAY 37
Mailing Address - City:INA
Mailing Address - State:IL
Mailing Address - Zip Code:62846
Mailing Address - Country:US
Mailing Address - Phone:618-437-5300
Mailing Address - Fax:
Practice Address - Street 1:251 NORTH ILLINOIS HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:INA
Practice Address - State:IL
Practice Address - Zip Code:62846
Practice Address - Country:US
Practice Address - Phone:618-437-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.001255363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical