Provider Demographics
NPI:1912980624
Name:GERTNER, JEFFREY WAYNE (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WAYNE
Last Name:GERTNER
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 1:21800 MARKET PL NW STE 103
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6667
Mailing Address - Country:US
Mailing Address - Phone:360-291-5700
Mailing Address - Fax:360-637-0863
Practice Address - Street 1:21800 MARKET PL NW STE 103
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6667
Practice Address - Country:US
Practice Address - Phone:360-291-5700
Practice Address - Fax:360-637-0863
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61659432207N00000X
IN01059625A2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN