Provider Demographics
NPI:1972989721
Name:GESULGA, JAYSON (PA)
Entity type:Individual
Prefix:
First Name:JAYSON
Middle Name:
Last Name:GESULGA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 70TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4825
Mailing Address - Country:US
Mailing Address - Phone:515-518-0460
Mailing Address - Fax:515-777-1950
Practice Address - Street 1:2327 70TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4825
Practice Address - Country:US
Practice Address - Phone:515-518-0460
Practice Address - Fax:515-777-1950
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IA081477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant