Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016003563 | IL |
Y | 222Z00000X | Podiatrist | 016003563 | IL |
NPI | 1063474633 |
---|---|
Provider Name | Robert Martin Gerber |
First Address | Evanston, IL 60202-3455 |
Second Address | Evanston, IL 60202-3455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 21/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016003563 | (05) | IL |
60001344 | BLUE CROSS BLUE SHIELD (01) | IL |
T38012 | (02) |