Provider Demographics
NPI:1386616316
Name:WILLIAM G GERLACH DPM, PC
Entity type:Organization
Organization Name:WILLIAM G GERLACH DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GERLACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-352-5436
Mailing Address - Street 1:16 HAMPTON VILLAGE PLZ
Mailing Address - Street 2:SUITE 274
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2128
Mailing Address - Country:US
Mailing Address - Phone:314-352-5436
Mailing Address - Fax:314-352-0749
Practice Address - Street 1:16 HAMPTON VILLAGE PLZ
Practice Address - Street 2:SUITE 274
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2128
Practice Address - Country:US
Practice Address - Phone:314-352-5436
Practice Address - Fax:314-352-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000454213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5544070001Medicare NSC
MO000014743Medicare PIN