Provider Demographics
NPI:1528123593
Name:GERBER, DANIEL J (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
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:PO BOX 1588
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80306-1588
Mailing Address - Country:US
Mailing Address - Phone:303-442-5492
Mailing Address - Fax:
Practice Address - Street 1:6658 GUNPARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3385
Practice Address - Country:US
Practice Address - Phone:303-449-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31508208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01315084Medicaid
COA63031Medicare UPIN
CO01315084Medicaid