Provider Demographics
NPI:1366513160
Name:GERHARDS, PAUL (LMT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GERHARDS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 NE 34TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-4376
Mailing Address - Country:US
Mailing Address - Phone:503-313-8366
Mailing Address - Fax:866-859-9183
Practice Address - Street 1:9860 SW HALL BLVD
Practice Address - Street 2:SUITE C-2
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8896
Practice Address - Country:US
Practice Address - Phone:503-313-8366
Practice Address - Fax:866-859-9183
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist