Provider Demographics
NPI:1992701544
Name:GJERTSON, ROBERT ALLAN (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLAN
Last Name:GJERTSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 W 126TH PLACE
Mailing Address - Street 2:
Mailing Address - City:OVELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6715 W 126TH PLACE
Practice Address - Street 2:
Practice Address - City:OVELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3230
Practice Address - Country:US
Practice Address - Phone:651-402-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN566213EP1101X, 213ES0131X
MO2012013991213EP1101X
KS12-00393213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN971371012008OtherPREFERREDONE
MN21250174910OtherBEECHSTREET
MN465TOGJOtherBCBS OF MN
MN27-00450OtherMEDICA
MNP00141474OtherRAILROAD MEDICARE
MN278018600Medicaid
MN686485OtherAMERICA'S PPO
MN114036OtherUCARE
MN5836442OtherAETNA
MN5836442OtherAETNA
MN278018600Medicaid
MN465TOGJOtherBCBS OF MN