Provider Demographics
NPI:1194992768
Name:GERK, CHARLES ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:GERK
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 1:1405 S 8TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4563
Mailing Address - Country:US
Mailing Address - Phone:970-522-3304
Mailing Address - Fax:
Practice Address - Street 1:1405 S 8TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4563
Practice Address - Country:US
Practice Address - Phone:970-522-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80874204Medicaid
COE05714Medicare UPIN
CO80874204Medicaid